The Curriculum Outline of PathphysiologyTotal period 108 Theory 78 Practice 30

Chapter Content Total period Theory Practice1 Introduction 1 12 General aspects

of altered health3 3

3 Water and electrolytes disturbances

16 11 5

4 Acid base disturbances

11 6 5

5 Edema 6 66 Hypoxia 11 6 57 Fever 6 68 Disseminated

intravascular coagulation

6 6

9 Shock 11 6 510 Respiratory

failure6 6

11 Heart failure 6 612 Hepatic

insufficiency11 6 5

13 Renal insufficiency

14 9 5

Total 108 78 30

Introduction to Pathophysiology Pathophysiology is one of basic biochemical science, but its study object is sick or disordered life. It is concerning the etiology and pathogenesis of diseases, as well as the mechanisms of functional and metabolic alterations in diseases.

Pathophysiology is the study of physiologic and biologic manifestations of disease and， the adaptations that the body makes to the changes produced by the disease process. It provides a theoretical basis for the prevention, diagnosis and treatment of disease by expanding the student’s knowledge in the sciences and exploring how alterations in structure (anatomy), metabolism (biochemistry) and function (physiology) disrupt the human body as a whole, and how these alterations produce signs and symptoms.

Pathophysiology emphasizes the dynamic aspects of disease. It is concerned with the disruption of the body’s homeostasis; alterations or derangement in functions, metabolisms, and mechanisms involved.

The development of diseases has its objective law, which could be elucidated more correctly by dialectical points of view, such as the viewpoint of that all things invariably divide into two, the viewpoint of the struggle, identity and transformation of contradictions etc. That is why some scholars recognize that pathophysiology as “Philosophy in Medicine”.

The content of pathophysiology including two parts: basic pathophysiology and clinic pathophysiology. Basic pathophysiology is concerned with disease and aging; responses of the body to pathogenic agents; the bodily defense mechanisms; disorder of internal environment; alterations in integrated body function; aIterations in cell function and growth, cellular and molecular aspects of disease. Clinic pathophysiology is concerned with system or organ dysfunction; pathophysiology in various diseases of diffrent organ systems.

Along with the development of cellular biology and molecular biology, the research in the mechanisms of disease has been depended. This has greatly enriched our knowledge of pathogenesis and the content of pathophysio1ogy course.

The position of pathophysiology in medical science is that it provides the common bond or bridge linking anatomy, physiology, and biochemistry to clinical practice. Although

pathophysiology is a young course, it is and frontier course which has close relationship with many other medical courses, especially with physiology.

The study methods for pathophysiology is that put stress on the essentials of pathophysiology; integrate and use the background information which you have learned from studying other basic medical sciences. Medical students learn the normal functions of organs and normal cellular metabolism in the courses of physiology and biochemistry. In the course of pathophysiology they will learn the alterations of function and metabolism and their mechanism in diseases, and their expression in patients. That means that the pathophysiology is one of the bridge courses between basic medical science and clinical medicine, which enables us to use the knowledge of basic medical science for the diagnosis and treatment of diseases.

The department of pathophysiology was set up in medical colleges of some countries (Russia, German and China etc) about half a century ago, since then the course of pathophysiology has been given in medical education. By learning from America and Europe in combination with the situation in above countries, a course of pathophysiology with special style has been established. In teaching program， the pathophysiology of common pathological processes, especially their pathogenesis is emphasized and systematically discussed.

As a result, pathophysiology is a young, frontier and bridge course, it is also philosophy in medicine. When the medical students studied the knowledge of pathophysiology, they will have the powerful weapon to diagnose and treat diseases.

The Teaching of Theory

Chapter 1 Introduction 11. Master the concept of pathophysiology.2. Master the focus of pathophysiology.3. Know well the content of pathophysiology .4. Know well the relationship between physiology, pathology and pathophysiology .5. Understand the position of pathophysiology in medical science.6. Understand the study methods of pathophysiology.EmphasisNature and aims of pathophysiology.DifficultyDefine and focus of pathophysiology.Content 1. Nature and aims of pathophysiology: nature, study characteristic, aim, focus, and development history2. Content of pathophysiology: the concept and content of basic pathophysiology and clinic pathophysiology 3. Position of pathophysiology in medical science4. Study methods for pathophysiologyReference Books1．L．H. Smith，Pathophysiology. The Biological Principles of Disease，5th edition， W.

B．Saunders Company, 1981．(6th edition, 1985)

2．S．A，Price，Pathophysiology. Clinical Concepts of Disease Processes， McGran-Hill

Book Company, 3rd edition, 1986．(4th edition，1992)

3．M．J．Miller, Pathophysiology Principles of Disease， W. B．Saunders Company,Philadelphia, 19834．W. A． Jr Sodeman, T.M Sodeman, Pathologic Physiology. Mechanisms of Disease 6th

edition W.B．Saunders Company, 1985

5．J．M Ramsey，Basic Pathophysiology, Addison-Wesley publishing Company, 1982 6. E. J. M.Campbell, Clinical Physiology, Blackwell Scientific publications, 5th Ed, 19847. C E, Kaufman, S. Papper，Review of Pathophysiology, Little，Browh and Company, 1983

8. Carol Porth，C. B. Pathopysiology. Concepts of Altered health states， Lippincot Company 1983 1st edition. (1994 4th edition)9. Kaufman，Essentials of Pathophysiology, Matthews Medical Book Co，1996

10. Bullock，Pathophysiology, Matthews Medical Book Co，1996

11. Corwin，Handook of Pathophysiology, Matthews Medical Book Co，1996

12. Copstead，Pathophysiology, Login Brothers Book Co Ine，1995

13. Hucther, Understanding Pathophysiology, Matthews Medical Book Co，199514.Kong Xianshou, Li Shunong, Wang Shuren, Contemporary Pathophysiology, Shanghai medical University Press, 199815. McPhee．SJ，Lingappa VR，Ganong WF, Pathophysiology of Disease, 3rd edition．New

York，McGraw-Hill companies Inc，2000

16. Ganong WF, Review of Medical Physiology. 20th edition ， NewYork ， McGraw-Hill

companies Inc，200117. Chris E kaufman, Patrick A Mckee. Essential of pathophysiology, 1 st Ed, Beijing: Peking union medical college press, 2002

Chapter 2 General Aspects of Altered Health 3 1. Master the concept of disease. 2. Master the etiology of disease.3. Master the pathogenesis of disease.4. Know well the cellular and molecular aspect of disease.5. Know well the outcome of diseases. EmphasisThe concepts health, disease, pathologic process and the relation of cause，conditional factor and precipitating factor.DifficultyConcept and diagnosis the brain death. Content 1. Basic concepts: health, disease, pathologic process, and syndrome.2. Cellular and molecular aspect of disease: alterations in cellular processes, stimuli that can cause cellular injury or adaptation, cellular adaptation, cell injury and death, alterations in cell growth and differentiation, molecular mechanisms of diseases.3. Developmental aspects of disease: concept of disease in children, concept of disease in older adult, etiology of disease, concept of etiologic factor, cause of disease, conditional factors.4. Outcome of diseases: complete recovery, incomplete recovery, and death.Reference Books1. Kaufman, Essentials of Pathophysiology, Matthews Medical Book Co, 19962. Bullock, Pathophysiology, Matthews Medical Book Co, 19963. Corwin, Handbook of Pathophysiology, Matthews Medical Book Co, 19964. Copstead, Pathophysiology, Login Brothers Book Co In, 19955. Hucther, Understanding Pathophysiology, Matthews Medical Book CO, 19956. Mccance，Pathophysiology Biological Basis for Disease in Adults and Children Maiors J A Co, 19947. Kong Xianshou, Contemporary Pathophysiology, Shanghai Medical University press, 19988. McPhee, SJ, Lingappa VR, Ganong WF, Pathophysiology of Disease, 3rd edition NewYork, McGraw-Hill companies Inc, 20009. Arthur C, Guyton.Human physiology and mechanisms of disease, 5 th Ed, W. B. Saunders Company, 1992, 2,19510. Ganong WF, Review of Medical Physiology, 20th ed，New York, McGraw-Hill, 2001

Chapter 3 Water and Electrolytes Disturbances 111. Master the disorders of water and sodium metabolism.2. Master the disorders of potassium metabolism. 3. Know well the body fluid and electrolytes balance.4. Know well the osmolality of the body fluids.5. Know well the mechanisms for regulating body fluid and electrolytes balance.6. Understand the disorders of magnesium metabolism.7. Understand the principle for treating water and electrolytes disturbances.

EmphasisCompare the effects of depletional hyponatremia, hypovolemic hypernatremia and normovolemic hypernatremia on the body, and compare effects of hypokalemia and hyperkalemia on the body.DifficultyThe effects of hypokalemia and hyperkalemia on the body in terms of nerve-muscular tissue and the heart.Content1. Body fluid and electrolyte balance: total fluid volume, body fluid distribution, and body fluid

composition.2. Osmolality of the body fluids3. Mechanisms for regulating body fluid and electrolyte balance: the sensation of thirst,

antidiuretic hormone, aldosterone, the natriuretic peptide family, the guanylin family.4. Disorders of water and sodium metabolism: hyponatremia, hypernatremia, disorders of water

and sodium metabolism with a normal serum sodium concentration. 5. Hyponatremia: hypovolemic hyponatremia, hypervolemic hyponatremia, normovolemic

hyponatremia.6. Hypernatremia: hypovolemic hypernatremia, hypervolemic hypernatremia, normovolemic

hypernatremia.7. Disorders of potassium metabolism: potassium content and distribution, maintenance of

potassium balance, potassium function.8. Hypokalemia: etiology and pathogenesis, alterations of metabolism and function.9. Hyperkalemia: etiology and pathogenesis, alterations of metabolism and function.10. Pathophysiological basis of prevention and treatment.11. Disorder of magnesium metabolism.12. Hypomagnesemia: etiology and pathogenesis, alterations of metabolism and function,

principles of treatment.13. Hypermagnesemia: etiology and pathogenesis, alterations of metabolism and function,

principles of treatment.

The Teaching of Practice Practice 1 Disorder of Potassium Metabolism 5Emphasis1. Master the concept, causes, and effect of hyperkalemia on heart. 2. Know well the change of electrocardiogram in hyperkalemia. 3. Understand the use of electrocardiogram machine.Content1. Study how to weigh, anesthesia, and fix the animals. 2. Make trachea cannula operation and chest operation.3. Study to connect electrodes and use electrocardiogram machine.4. Study to observe and analyze the shape of electrocardiogram. Homework1. Write the experiment report.2. Explain the cause, mechanisms and effects of hyperkalemia on the heart.3. Describe the change of electrocardiogram in hyperkalemia. Reference Books1. Juha P Kokko, Disorder of fluid volume, electrolyte, and acid-base balance. J. Claude Bennett, Fred Plum.Cecil textbook of medicine.20th ed. W. B. Saunders Company. 1996, 5252. Arthur C, Guyton, Human physiology and mechanisms of disease.5 th ed. W. R. Saunders Company.1992, 2, 1953. Chris E Kaufman, Patrick A Mckee. Essentials of pathophysiology，1st ed. Beijing：Peking union medical college press, 2002, 5474. Bruce C Kone, Molecular biology of natriuretic peptides and nitric oxide syntheses. Cardiovascular Research, 2001, 51：429-4415. Peter Agre, David Kozono. Aquaporin water channels:Molecular mechanism for human diseases. FEBS Letters, 2003, 555：72-786. Leonard R Forte. Guanylin regulatory peptides: Structures, mediated by cyclic GMP and pathobiology. Regulatory Peptides, 1999, 81: 25-397. Stephen C Cannon. An expanding view for the molecular basis of familial periodic

Paralysis. Neuromuscular Disorders, 2002, 12：533-543

biological activities 1999。81：25—39 of familial periodic8. Deborah B Diercks, George M Shumaik, Richard A Harrigan, et a1. Electrocardiographic manifestations：Electrolyte abnormalities. The Journal of Emergency Medicine, 2004, 27(2)：153-1609. Jurgen Vormann. Magnesium: Nutrition and metabolism. Molecular aspects of

Medicine, 2003, 24：27-3710. Michael I, Pearl, Dayna I, McCauley. Management of hypercalcemia of malignancy. Prim Care Update Ob/Gyns, 1996, 3：163-166

Chapter 4 Acid-Base Disturbances 61. Master the simple acid-base disorders: concept, primary causes, compensation, alteration of metabolism and function.2. Master the laboratory tests: pH, PaCO2, [HCO3-], Anion Gap. 3. Know well the regulation of pH: buffer systems, respiratory regulation mechanisms, and renal regulation mechanisms. 4. Know well the acid-base biochemistry: generation of acids and bases, Henderson-Hasselbalch equation. 5. Understand the mixed acid-base disorders and judgment of acid-base disorders.6. Understand the principle for treating acid-base disturbances.EmphasisThe concept, causes, changes in arterial blood gases, manifestations of four simple acid-base disorders. DifficultyThe arterial blood gas changes in the four simple acid-base disorders and AG’s significant.Content1. Acid-base biochemistry: generation of acids and bases, Henderson-Hasselbalch equation.2. Regulation of pH: buffer systems, respiratory regulation mechanisms, and renal regulation mechanisms.3. Laboratory Tests: pH, PaCO2, [HCO3-], Anion Gap.4. Simple acid-base disorders: concept of simple acid-base disorders, compensation for simple acid-base disorders.5. Metabolic Acidosis: concept, primary causes, compensation, alteration of metabolism and function.6. Respiratory Acidosis: concept, primary causes, compensation, alteration of metabolism and function.7. Metabolic Alkalosis: concept, primary causes, compensation, alteration of metabolism and function.8. Respiratory Alkalosis: concept, primary causes, compensation, alteration of metabolism and function.9. Mixed acid-base disorders: metabolic alkalosis plus metabolic acidosis, metabolic acidosis plus respiratory alkalosis, metabolic acidosis plus respiratory acidosis, metabolic alkalosis plus respiratory alkalosis, metabolic alkalosis plus respiratory acidosis, triple acid-base disorders, judgment of acid-base disorders.

Practice 2 Case Presentation 5Emphasis1. Master the simple acid-base disorders: concept, primary causes, compensation, alteration of metabolism and function.2. Master the laboratory tests: pH, PaCO2, [HCO3-], Anion Gap.3. Know well the classification and judgment of mixed acid-base disorders.4. Understand the principle for treating acid-base disturbances.Content 1. Study to analyze case reports of patients.2. Try to make diagnosis according to laboratory tests.3. Master the diagnosis of four kinds of simple acid-base disorders.4. Know the diagnosis of mixed acid-base disorders.

5. Case reports: (1) Simple acid-base disorders: metabolic acidosis, respiratory acidosis, metabolic alkalosis, and respiratory alkalosis.(2) Mixed acid-base disorders: metabolic alkalosis plus metabolic acidosis, metabolic acidosis plus respiratory alkalosis, metabolic acidosis plus respiratory acidosis, metabolic alkalosis plus respiratory alkalosis, metabolic alkalosis plus respiratory acidosis.(3) Triple acid-base disorders: metabolic acidosis plus metabolic alkalosis plus respiratory acidosis, metabolic acidosis plus metabolic alkalosis plus respiratory alkalosis.Homework1. Write the experiment report.2. Explain the cause, mechanisms and effects of acid-base disorders.3. Describe the change in arterial blood gases, laboratory tests in acid-base disorders.Reference Books1. James E, Bourdeau, Acid-Base disturbances, Chris E, Kaufman, Patrick A, McKee, Essentials of Pathophysiology , Beijing：Beijing Union Medical College Press, 2002, 569

2. Yang Qin, Acid-Base disturbances，Wang Shuren, Pathophysiology，Chengdu：Sichuang University Press, 2004, 51 3. Benjamin Abelow, Understanding acid-base, 1st ed，Baltimore：Williams&Wilkins，1998, 514. Joseph I, Shapiro and William D, Kaehny, Pathogenesis and management ofMetabolic acidosis and alkalosis, Robert W, Schrier, Renal and electrolyte disorders. 6 th

ed，Philadelphia：Lippincott Williams&Wilkin，2003, 115 Chapter 5 Edema 61.Master the basic mechanisms of edema2 Master the basic mechanisms of pulmonary edema and cerebral edema.3.Know well the define of edema， pitting and nonpitting edema, frank and recessive edema, interstitial pulmonary edema and alveolar edema, cerebral edema.4. Understand the retention of sodium and water involved in generalized edema.5. Understand the manifestations and effect of edema. 6. Understand the principles of treatment of pulmonary edema and brain edemaEmphasisThe basic mechanisms of edema DifficultyThe factors that control fluid exchange at the capillary and kidney; the development of edema. Content 1. Introduction: concept, classification, manifestations, causes.2. The mechanisms of edema: imbalance between the formation and removal of interstitial fluid,

regulation of interstitial fluid volume, mechanisms that produce increased interstitial fluid volume in local tissues, imbalance of body fluid intake and output.

3. Pulmonary edema: concept, mechanisms and causes, effects of pulmonary edema, principles of treatment.

4. Brain edema: concept, mechanisms and causes, effects of brain edema, principles of treatment.

Reference Books1. James E, Bourdeau, Acid-Base disturbances, Chris E, Kaufman, Patrick A, McKee, Essentials of Pathophysiology , Beijing：Beijing Union Medical College Press, 2002, 569

2. Yang Qin, Acid-Base disturbances，Wang Shuren, Pathophysiology，Chengdu：Sichuang University Press, 2004, 51 3. Benjamin Abelow, Understanding acid-base, 1st ed，Baltimore：Williams&Wilkins，1998, 514. Joseph I, Shapiro and William D, Kaehny, Pathogenesis and management ofMetabolic acidosis and alkalosis, Robert W, Schrier, Renal and electrolyte disorders. 6 th

ed，Philadelphia：Lippincott Williams&Wilkin，2003, 115 Chapter 6 Hypoxia 6

1.Master the characteristics of blood oxygen change in four kinds of hypoxia. 2.Master the mechanisms of hypoxia.3.Master the compensatory response and injurious response in four kinds of hypoxia.4.Know well the classification and etiology of hypoxia.5.Know well the factors involved in tolerance to hypoxia. 6.Understand the concepts of oxygen treatment and oxygen toxicity.EmphasisThe characteristics of blood oxygen change in four kinds of hypoxia.DifficultyThe compensatory response and injurious response of hypoxia.Content 1. Parameters of blood oxygen: partial pressure of oxygen, oxygen capacity, oxygen content, and oxygen saturation, P50.2. Classification, etiology and pathogenesis of hypoxia: hypotonic hypoxia, hemic hypoxia, circulatory hypoxia, histogenous hypoxia.3. Alterations of function and metabolism: respiratory system, circulatory system, hemic system, central nervous system, and cellular alterations.4. Factors affecting the tolerance to hypoxia: oxygen consumption rate, compensatory ability of the body.5. Oxygen therapy and oxygen intoxication: pulmonary oxygen intoxication, cerebral oxygen intoxication.

Practice 3 Hypoxia 5Emphasis 1. Master the mechanism and characteristics in different kinds of hypoxia. 2. Master the effects and manifestation of hypotonic and hemic hypoxia on the body.3.Know well the compensatory and injurious response in hypotonic and hemic hypoxia.4. Understand the methods and role of copy hypoxia models.Content 1. Copy mouse models of hypotonic hypoxia.2. Install the equipment of CO producing device and copy mouse models of hemic hypoxia. 3. Copy mouse models of sodium nitrite toxic hypoxia and learn injection from abdomen. 4. Observe and record the mouse’s respiratory rate, color of skin and lip mucous membrane, recognizing the different signs of different kinds of hypoxia5. Try to treat the mouse of hemic hypoxia. Homework1. Write the experiment report with table.2. Explain the cause, mechanisms and effects of different kinds of hypoxia. 3. Describe the change of respiratory rate, color of skin and lip mucous membrane and why to occur these changes. Reference Books1. Dong Chuanren, The disorder of oxygen utilization. Wang Dixun, Jin Huiming, Pathophysiology, 2nd ed, Beijing: People’s Medical Publishing House, 20022． Kaufman CE， McKee PA． Essentials of Pathophysiology， Beijing: Xiehe Medical

University of China Press，2002

3．Guyton AC，Hall JE．Textbook of Medical Physiology，10th ed，Beijing: Beijing Medical

University Press，2002

4. McPhee SJ， Lingappa VR，Ganong WF， Lamge JD． Pathophysiology of Disease; an

introduction to clinical medicine，3rd ed，New York：McGraw Hill，2000

5．Ganong WF．Review of Medical Physiology，20th ed，Beijing: People’s Medical Publishing House, 20016．Lingappa VR，Farey K．Physiological Medicine： a clinical approach to basic medical

physiology，Beijing: Science Press，2001

Chapter 7 Fever 61. Master the etiology, concept of fever.

2. Master the pathogenesis, classification and action of endogenous pyrogen.3. Master the thermoregulation of fever.4. Know well the classification and action of pyrogenic activators, central febrile mediators.5. Know well the regulation of normal body temperature.6. Know well the alterations of metabolism and function of fever.7. Understand the biochemical significant and principle of treatment in fever.EmphasisThe etiology, concept of fever.DifficultyThe thermoregulation of fever and the endogenous pyrogen.Content 1. Regulation of normal body temperature.2. Etiology: infectious factors, non-infectious factors.3. Pathogenesis: endogenous pyrogens.4. Thermoregulation of fever: thermoregulating center, routes of peripheral pyrogenic signals into

thermoregulation center, central mediators of fever.5. Alterations of metabolism and function.6. Pathophysiological basis of prevention and treatment.Reference Books1. Leon LR．Invited review：cytokine regulation of fever：Studies using gene knockout

mice．J. Appl Physiol，2002，92 (6) ：2648-2655

2. Hasday JD，Fairchild KD，Shanholtz C．The role of fever in the infected host． Microbes and infection，2002，2(15)：1891-1904

3. Zeisberger E． From humoral fever to neuroimmunological control of fever． Journal of

Thermal Biology，1999，24(5-6)：287-326

4. Mihai G Netea， Bart Jan Kullberg， Jos WM Van der Meer． Circulating cytokines as

mediators of fever．Clinical Infectious Diseases，2000，31(supp 5)：S178-184

5. Blatteis CM, Li SX．Pyrogenic signaling via vagal afferents．What stimulate their

receptors? Autonomic Neuroscience：Basic and Clinical，2000，85(1-3)：66-71

6. Steiner AA，Branco LG．Nitric oxide in the regulation of body temperature and

fever．Journal of Thermal Biology，2001，26(4-5)：325-330

7. Roth J. Zeisberger E，Vybiral S．Endogenous antipyretics：neuropeptides and

glucocorticoids．Front Biosci，2004，9(1)：816-826

8. Sinha PS，Schioth HB，Tatro JB．Roles of the melanocortin-4 receptor in antipyretic and

hyperthermic actions of centrally administered a-MSH．Brain Research，2004，1001(1-2)：150-1599. Lia SX， Goorhab S， Ballou LR， Blatteins CM． Intracerebroventricular interleukin-

6， macrophage inflammatory protein-1 and IL-18 ： pyrogenic and PGE2-mediated? Brain

Research，2003，992(1)：76-84

10．Wang Huadong，Wang Yanping，Qu Yang，et a1．The camp-mediated protein

kinase signal transduction pathway is involved in the pyrogenic effect of CRH in rats．Chin

Med J，2001，114(10)：1064-1067

Chapter 8 Disseminated intravascular coagulation (DIC) 61. Master the concept, etiology, pathogenesis; factors influence the development of DIC.2. Know well the clinical classification and alterations of metabolism and function of DIC. 3. Know well the stages of DIC.4. Understand the laboratory test of DIC.5. Understand pathophysiological basis of prevention and treatment of DIC.EmphasisConcept, pathogenesis and consequences of DIC.Difficulty

Intrinsic and extrinsic clotting pathway, mechanism of FDP, microangiopathic hemolytic anemia.Content 1. Overview of haemostatic System: vasospasm, coagulation system, anticoagulation system, function of the fibrinolytic system, and role of endothelial cells.2. Imbalance in haemostatic system: bleeding disorders, thrombogenesis and thrombotic disorders, blood vessel abnormity, fibrinolytic factor abnormality.3. Disseminated intravascular coagulation: etiology, pathology, pathogenesis, factors influence the development of DIC, clinical classification of DIC, alterations of metabolism and function, pathophysiological basis of prevention and treatment.Reference Books1．Esmon CT．Thromhomodulin as a model of molecular mechanisms that modulate

protease specificity and function at the vessel surface．FASEB J，1995，(9): 946-955

2．Lynn M，O’Brien，Maria Mastri et al．Regulation of factor VIIIa by human activated

protein C and protein S： inactivation of cofactor in the intrinsic factor Xa．BLOOD, 2000,

95(5)：1714-1719

3．John A．Samis，Gillian D．Ramsey，John B．Walker，et al．Proteolytic processing of

human coagulation factor IX by plasmin．BIOOD，2000，95(3)：943-951

4．Marlar RA．The protein-C system--how complex is it? Thromb Haemost，2001，85：756-757

5．Wang W，et a1．A study of the mechanism of inhibition of fibrinolysis by activated

thrombin-activatable fibrinolysis inhibitor．J Biol Chem，1998，273：27176-27181

6．David V．Kuter，Hemostasis and thrombosis．Ernest Beutler，Barrys．Coller，Marshalla．Lichtman． Williams Hematology，6th New York： McGraw-Hill

Companies，2001，1339-1829

7． Bachmann F． The plasminogen-plasmin enzyme system． In： Colman RW， Hirsch

J，Marder VJ，Salzman EW，eds．Hemostasis and thrombosis：Basic principles and

clinical practice，3rd ed．Philadelphia：J．B．Lippincott，1993，1592

8．Declerck PJ，Juhan-Vague I，Felez J，et a1．Pathophysiology of fibrinolysis．J Intern

Med，1994，236：425．9．Mann KG．Biochemistry and physiology of blood coagulation．Thromb Haemost，1999，82：165-174

10．Ten Cate H．Pathophysiology of disseminated intravascular coagulation in sepsis．Crit Care Med, 2000，28：S9-S11

Chapter 9 Shock 61. Master the concept, etiology and classification of shock.2. Master the stages of shock and their pathological changes and compensatory mechanisms.3. Know well the roles of humeral factors in pathogenesis of shock.4. Know well the functional and metabolic changes.5. Understand the pathophysiological basis of prevention and treatment for shock.6. Understand the organic dysfunction syndrome.EmphasisThe etiology, concept of shock.DifficultyThe alteration of microcirculation, tissue perfusion and manifestation of three stages.Content 1. Etiology and classification: hypovolemic shock, cardiogenic shock, infectious shock, anaphylactic shock, neurogenic shock. 2. Stages of shock and their pathological changes: ischemic hypoxia stage, stagnant hypoxia stage, and organic failure stage.3. Roles of humeral factors in pathogenesis of shock: catecholamine and angiotensin, cytokines, adhesion molecules, endothelium-derived vocative mediators, activation of complement cascade,

lysosomal enzymes, redox imbalance.4. Functional and metabolic changes: neuroendocrine system, cardiovascular system, hematologic system, immune system, lung, kidney, gastrointestinal, liver, metabolic derangement, cellular responses.5. Pathophysiological basis of prevention and treatment for shock: volume replacement, application of vasoactive drugs, treatment on acidosis, treatment of DIC or organic dysfunction, others.6. Multiple organ dysfunction syndromes: systemic inflammatory response, compensatory anti-inflammatory response syndrome, and mixed antagonist response syndrome.

Practice 4 Shock 5 Emphasis1. Master the mechanism and characteristic in hemorrhagic shock.2. Master the effects and manifestation of hemorrhagic shock on the body.3. Know well the compensatory and injurious response in hemorrhagic shock.4. Understand the methods and role of copy hemorrhagic shock models.5. Understand the principle of treatment in hemorrhagic shock.Content 1. Weigh, anesthesia, and fix the animals.2. Make trachea cannula operation.3. Separate arteria carotis communis, vena jugularis externa and arteria femoralis , then insert cannulas.4. Connect energy transmitter equipment for observing the change of blood pressure. 5. Copy rabbit models of hemorrhagic shock.6. Observe the response of rabbit (respiratory rate, blood pressure, heart rate and urine volume).7. Try to treat the hemorrhagic shock rabbit by injecting solution and blood.8. Observe the effect of treatment and record the changes of respiratory rate, blood pressure, heart rate and urine volume.Homework1. Write the experiment report. 2. Explain the pathogenesis, compensatory mechanisms and effects of hemorrhagic shock on the body.3. Describe the change of respiratory rate, blood pressure, heart rate and urine volumeand why treatment has very good effect to hemorrhagic shock.Reference Books1. Porth CM. Pathophysiology, concept of altered health states. 6 th ed. Lippincott,

Williams&Wilkin Inc，2002, 562-5642. McCance KI, Huether SE. Pathophysiology, the biologic basis for disease in adults and

children, 4th ed, St. Louis, Missouri, Mosby Inc. 2002,1483-14913. Mcphee SJ. Lingappa VR AND Ganong WF, Pathophysiology of disease, 4 th ed, New York,

Lange Medical Book, McGraw-Hill. 2003, 1492-14964. Kumarpe CM. Clinical Medicine, 5th ed, Edinburgh: W.b. Sauders, 2002,927-9295. Goldman I, Bennett JC. Cecil Textbook of Medicine, 21st ed, Philadelphia:W.B.Sauders

Comp.2000, 495-5016. Warrell DA, Cox TM, Firth JD, et al. Oxford Textbook of Medicine, 4th ed, Oxford University

Press, 2003, 1220-12247. Braunwald E, Fauci AS, Kasper DL, et al. Harrison’s Principle of Internal Medicine, 15 th ed,

New York: McGraw-Hill, Medical publishing division, 2001, 222-2268. Human HD, Kelley’s Textbook of Internal Medicine. 4th ed, Lippincott, Williams&Wilkin

Inc，2000, 417-4209. Jevon P. Ewen B. Monitoring the Critically Ill Patient. Oxford, Blackwell Science, 2002, 69-

7210. Phipps WJ. Medical-Surgical Nursing Health and Illness Perspectives, 7 th ed, Mosby St.

Louis, 2003, 283-29311. Tierney LM, Mcphee SJ and Papadakis MA. Current Medical Diagnosis and Treatment. 4 th

ed, Lange Medical books, New York, 2004, 458-461

Chapter 10 Respiratory Failure 6

1. Master concept, etiology and pathogenesis of respiratory failure. 2. Master the blood–gas changes of respiratory failure.3. Know well the alterations of function and metabolism of respiratory failure.4. Know well the concept, causes and pathogenesis of ARDS.5. Understand the pathophysiological basis of treatment.EmphasisConcept, pathogenesis and blood–gas changes of respiratory failure.DifficultyDifference between types I and type II of respiratory failure in pathogenesis and treatment.Content 1. Etiology and pathogenesis: ventilatory disorder, diffusion disorder, ventilation and perfusion imbalance, and anatomic shunt.2. Alterations of function and metabolism: acid-base imbalance and electrolyte imbalance, respiratory system, cardiovascular system, and central nervous system.3. Pathophysiological basis of treatment: treating the causes of respiratory failure, increasing PaO2, decreasing PaCO2, and treating the consequences of hypoxemia and hypercapnia.Reference Books1. Jin Xianrong, Respiratory Failur. Wang Dixun, Jin Huiming, Pathophysiology, 2nd Ed, and Beijing: People’s Medical Publishing House, 2002, 9292. Zhong Nanshan. Fighting SARS in grand collaboration：Our strategies．Chinese Med J, 2003,

116(6)：803

3. Roussos C and Koutsoukou A．Respiratory failure．Eur Respir J，2003，22：Suppl．4 73s

4. Crapo JD ， G1assroth J ， Karlinsky J ， King TE ． Baum’s Textbook of Pulmonary

diseases．7th ed，USA，Lippincott Williams and Wilkins，2004，1103

5. Seaton A and Seaton D ． Crotton and Douglas’ Respiratory Diseases ． 5th ed.

Oxford，Blackwell Science Ltd 2000．696

6．Criner GJ． and D’Alonzo GE． Pulmonary Pathophysiology 1st ed，USA，Blackwell

Science．Inc，1999．171

7. Fishman AP．Fishman's Pulmonary Diseases and Disorders．3rd ed，Singapore Mc Grw-Hill

Companies Inc，1998, 2526 8. Nunn’s Applied Respiratory Physiology, 4th ed, Bufferworth-Heinermann Ltd, 1993, 117, 156, 418, 505

Chapter 11 Heart Failure 61. Master the concept, etiology and classifications of heart failure. 2. Master the pathogenesis and compensatory responses of heart failure.3. Know well the alterations of metabolism and function of heart failure. 4. Understand the principles of treatment of heart failure.EmphasisEtiology and pathogenesis of heart failure.DifficultyDysfunction of excitation-contraction coupling.Content 1. Etiology and classifications: underlying causes, precipitating factors, classifications.1. Pathogenesis: decreased myocardial contractility, diastolic dysfunction, asynergic myocardial

contraction and relaxation, endothelial dysfunction.2. Compensatory responses: cardiac compensation, systemic compensation, neurohormonal

compensation.3. Alterations of metabolism and function: congestion of pulmonary circulation, congestion of

systemic circulation, low cardiac output.4. Principles of treatment: general treatment, improving cardiac functions, reducing afterload

and preload, regression of ventricular hypertrophv, controlling edema.Reference Books1 ． Thadani U, Congestive heart failure, Kaufman CE, Mckee PA. Essentials of

pathophysiology ， Beijing ， Lippincot Wilkins and Peking Union Medical College

press，2002，91

2. Guyton AC，Hall JE. Cardiac failure, Guyton AC，Hall JE．Textbook of medical physiology

10th ed, Beijing, Health Sciences Asia ， Elsevier Science and Beijing Medical University

Press，2002，235

3. KuSumotoF ， Cardiovascular disorders ： heart disease ， Mcphee SJ ， Lingappa

VR．Ganong WF，et al，Pathophysiology of disease．An introduction to clinical medicine, 3rd

ed, Beijing，Mcgraw-Hill and People’s Health Press，2001, 222

4. Francis GS， Tang WHW， Kaufman LH， et a1． Pathophyology of congestive heart

failure，Rev Cardiovas Med，2003；4(suppl 2)：S14-S20

5. Bachetti T. Current perspectives．Endothelial dysfunction in chronic heart failure, some new

basic mechanisms，Ital Heart J，2000，l (10) ：656-661

6. Shah M, Ali V，Lamba S．pathophysiology and clinical spectrum of acute congestive heart

failure，Rev cardiovas Med，2001，2(suppl 2)：S2-S6

7. Mann DI. Stress-activated cytokines and the heart failure ： from adoption to

maladaption，Annu Rev physiol，2003．65：81-101

8. Frey N，0lson EN. Cardiac hypertrophy： the good， the bad，and the ugly，Annu Rev

Physiol，2003，65：45-79

9. Van Bilsen M, Smeets PJH，GiIde AJ，et a1．Metabolic remodeling of the failing heart: the

cardiac burnout syndrome? Cardiovas Res．2004．61：218-226

Chapter l2 Hepatic Failure 61. Master the concept, etiology, classification, pathogenesis and precipitating factors of hepatic encephalopathy.2. Know well the concept, etiology and manifestation of hepatic insufficiency.3. Know well pathogenesis of hepatorenal syndrome.4. Understand principles of treatment and prevention for hepatic encephalopathy, hepatic insufficiency and hepatorenal syndrome.EmphasisThe pathogenesis of hepatic encephalopathy.DifficultyThe relation among four kind of hypothesises of hepatic encephalopathy.Content1. Etiology of hepatic insufficiency: injury of hepatocytes and hepatic dysfunction, metabolic disorders of water and electrolytes, disorders in production of bile salts and elimination of bilirubin disorders, hepatic enteric endotoxemia.2. Hepatic encephalopathy: etiology, classification, pathogenesis (ammonia intoxication, false neurotransmitters and amino acid imbalance, the gamma-aminobutyric acid hypothesis), precipitating factors and principles of treatment3. Hepatorenal syndrome: pathogenesis (stimulated sympathetic nervous system, activated renin-angiotensin-aldosterone system, increased vasopressin release, other humoral factors), principles of treatment and prevention.

Practice 5 Hepatic Encephalopathy 5Emphasis1. Master the mechanism and characteristic in hepatic encephalopathy. 2. Master the effects and manifestation of hepatic encephalopathy on the body.3. Know well the compensatory and injurious response in hepatic encephalopathy. 4. Understand the methods and role of copy hepatic encephalopathy models. Content 1. Set up two groups of rabbits, one is experiment group; another is control group.2. Weigh, local anesthesia, and fix two group animals. 3. Make the operation of ligating the liver only to experiment group.4. Make the operation of duodenum cannula, then insert cannulas to two groups.

5. Copy rabbit models of hepatic encephalopathy by inputting NH4Cl solution.6. Observe the response of rabbit (respiratory rate, responsibility, muscle twitching and decerebrum rigidity).7. Try to treat the hepatic encephalopathy rabbit by injecting acid solution.Homework1. Write the experiment report.2. Explain the pathogenesis, compensatory mechanisms and effects of hepatic encephalopathy on the body.3. Describe the difference of manifestation between two groups rabbits and explain the cause.Reference Books1. McCance KC&Huether SE．The biological basis for disease in adults and children．Pathophysiology．4th ed，Mosby，St. Louis，2002

2. Wang SR．Pathophysiology，Beijing：Science Press，2001

3. Huether SE and McCance KL．Understanding Pathophysiology．2nd ed，Mosby Inc，20004. Porth CM＆Kunert. MP．Concept of altered health states．Pathophysiology，6th ed，Lippincott Wllliams&Wilkins．2002

5. Jones EA．Pathogenesis of hepatic encephalopathy．Clin Liver Dis，2000，4(2)：467- 485

6. Roey GV and Moore K．The hepatorenal syndrome．Pediatr Nephrol，1996，10：100-107

7．Bain VG．Hepatorenal syndrome，hepatopulmonary syndrome，and now，hepatospinal syndrome? liver Transpl，2003，9(9)：995-996

8. Gines P，Guevara M，Perez-Villa F．Management of hepatorenal syndrome：Another piece

of the puzzle．Hepatology，2004，40(1)：16-18

9. Gines P ， Guevara M ， Arroyo V ， et a1 ． Hepatorenal

syndrome．Lancet，2003，362(9398): 1819-1827

Chapter l3 Renal Failure 91. Master the concept, etiology, classification, pathogenesis, and alterations of metabolism and function of acute renal failure. 2. Master the concept, etiology, clinical courses and pathogenesis of chronic renal failure.3. Master the concept of uremia.4. Know well the mechanism of compensation and decompensation, alterations of metabolism and function of chronic renal failure.5. Know well the pathogenesis, functional and metabolic alterations of uremia.6. Understand principles of treatment and prevention of renal failure.EmphasesPathogenesis and clinical course of acute renal failure and chronic renal failure.DifficultyPathogenesis of chronic renal failure.Content 1. Basic pathological techs for renal failure: dysfunction of glomerular filtration, renal tubular dysfunction, and renal endocrine dysfunction.2. Acute renal failure: etiology, classification, pathogenesis, alterations of metabolism and function and pathophysiological basis of prevention and treatment.3. Chronic renal failure: etiology, clinical courses, pathogenesis, mechanism of compensation and decompensation, alterations of metabolism and function and pathophysiological basis of prevention and treatment.4. Uremia: pathogenesis, functional and metabolic alterations and pathophysiological basis of prevention and treatment.

Practice 6 Acute Renal Failure 5Emphasis1. Master the mechanism and characteristic in acute renal failure.2. Master the effects and manifestation of acute renal failure on the body.

3. Know well the compensatory and injurious response in acute renal failure.4. Understand the methods and role of copy acute renal failure models.Content1. Set up two groups of rabbits, one is experiment group; another is control group.2. Copy rabbit models of acute renal failure by injecting HgCl2 solution.3. Weigh, anesthesia, and fix two group animals.4. Make the ureter catheter operation and collecting urine for test.5. Make the arterial catheter operation and collecting blood for test.6. Study to do laboratory test: protein urine content, BUN content, Scr, PSP.7. Compare the differences of laboratory test between two groups’ rabbits.Homework1. Write the experiment report. 2. Explain the pathogenesis, mechanisms and effects of acute renal failure on the body.3. Describe the difference of laboratory test between two groups rabbits and explain the cause.Reference Books1．Xu Changqing, Renal Insufficiency． Jin Huiming, Wang Jianzhi, Pathophysiology, 6th ed,

Beijing: People’s Medical Publishing House, 2004，264-282

2. Vishwanath R and Lingappa ， Renal Disease ， Stephen J and Mcphee ， et

a1．Pathophysiology of disease， 3rd ed, Mc Grw-Hill Companies, 2000

3. Richard E Gilbert，et al，Novel approaches to the treatment of progressive renal

disease．Current opinion in Pharmacology，2001．1：183-189

4. Ricardo Rocha and Charles T． Stier， Jr． Pathophysiological effects of aldosterone in

cardiovascular tissues．Trend in Endocrinology&Metabolism，2001，12(7)：308-3145. Mai Ots，et al．Characteristics of progressive renal disease．Clinica Chimica Acta,

2000, 297：29-41

6. Naveen Singri，et al．Acute renal failure．JAMA，2003，289(6)：747-751

7. Leon F．Ferder，et al．Effects of rennin-angiotensin system blockade in the aging

kidney．Experimental Gerontology，2003, 38：237-244

8. Christine G Schnackenberg ． Oxygen radicals in cardiovascular-renal disease ． Current

Opinion in Pharmacology, 2002, 2：121-125

9. Marta Ruiz-Ortega，et al．Angiotensin II regulates the synthesis of proinflammatory

cytokines and chemokines in the kidney．Kidney International，2002，62，Supp(182)S12-S2210. Shokei KM and Hiroshiiwao ． Molecular and Cellular Mechanisms of Angiotensin II-

Mediated Cardiovascular and Renal Diseases．Pharmacological RevieW8。2001, 52

(1)：11-34

11.Sharon Phillips Andreoli, Acute renal failure. Curr Opin Pediatr，2002，14：183-188

12. Ravi Thadhani, Manuel Pascual and Joseph V-Bonventre．Acute Renal Failure．The New England Journal of Medicine，1996，334(22)：1448-1460