病理生理学 英文版2025|PDF|Epub|mobi|kindle电子书版本百度云盘下载

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Chapter 1 Concept of Disease1

A Historical Perspective on Disease1

A General Introduction to Disease3

Health3

Disease as States of Adaptation3

Disease Etiology,Pathogenesis and Outcome4

Etiology4

Causative Factors4

Predisposing Factors5

Precipitating Factors6

Pathogenesis6

General Rule for Pathogenesis of Diseases6

Fundamental Mechanisms for Diseases7

Outcome8

Complete Recovery8

Incomplete Recovery8

Death8

Prevention of Diseases9

Evidence-based Practice and Practice Guidelines of Disease10

Chapter 2 Fluid and Electrolyte Balance and Imbalance11

Body Fluid and Electrolyte Balance11

Volume,Distribution and Composition of Body Fluids11

Total Fluid Volume11

Body Fluid Distribution12

Body Fluid Composition12

Osmolality of the Body Fluids13

Mechanisms for Regulating Body Fluid and Electrolyte Balance15

Thirst15

Antidiuretic Hormone(ADH)15

The Renin-Angiotensin-Aldosterone System17

The Natriuretic Peptide Family17

The Guanylin Family18

Disorders of Water and Sodium Metabolism19

Hyponatremia20

Hypovolemic Hyponatremia20

Hypervolemic Hyponatremia21

Normovolemic Hyponatremia22

Hypernatremia23

Hypovolemic Hypernatremia23

Hypervolemic Hypernatremia24

Normovolemic Hypernatremia25

Disorders of Water and Sodium Metabolism with A Normal Serum Sodium Concentration25

Isotonic Dehydration25

Edema25

Disorders of Potassium Metabolism28

Potassium Homeostasis28

Potassium Content and Distribution28

Maintenance of Potassium Balance28

Potassium Function30

Hypokalemia32

Etiology and Pathogenesis32

Alterations of Metabolism and Function34

Hyperkalemia36

Etiology and Pathogenesis36

Alterations of Metabolism and Function37

Pathophysiological Basis of Prevention and Treatment38

Disorders of Magnesium Metabolism38

Magnesium Homeostasis38

Hypomagnesemia40

Etiology and Pathogenesis40

Alterations of Metabolism and Function40

Principles of Treatment41

Hypermagnesemia41

Etiology and Pathogenesis41

Alterations of Metabolism and Function41

Pathophysiological Basis of Prevention and Treatment42

Disorders of Calcium and Phosphorus Metabolism42

Calcium and Phosphorus Homeostasis42

Function of Calcium and Phosphorus43

Hypocalcemia43

Etiology and Pathogenesis43

Alterations of Metabolism and Function44

Pathophysiological Basis of Prevention and Treatment45

Hypercalcemia45

Etiology and Pathogenesis45

Alterations of Metabolism and Function45

Pathophysiological Basis of Prevention and Treatment46

Hypophosphatemia46

Etiology and Pathogenesis46

Alterations of Metabolism and Function46

Principles of Treatment47

Hyperphosphatemia47

Etiology and Pathogenesis47

Alterations of Metabolism and Function47

Principles of Treatment47

Case Presentation47

Chapter 3 Acid-Base Balance and Disturbances52

Acid-Base Chemistry52

Generation of Acids and Bases52

Henderson-Hasselbalch Equation53

Regulation of pH53

Buffer Systems53

Bicarbonate Buffer System54

Protein Buffer System54

Respiratory Regulatory Mechanisms54

Renal Regulatory Mechanisms55

Bicarbonate Conservation55

Bicarbonate Reclamation by Proximal Tubule55

Bicarbonate Regeneration by Distal Tubule and Collecting Duct56

Hydrogen Ion Elimination(Acid Excretion）56

Impact Factors for H+ Elimination57

Laboratory Tests58

pH59

PaCO259

[HCO- 3]59

Anion Gap(AG)60

Simple Acid-Base Disorders60

Concept of Simple Acid-base Disorders60

Compensation for Simple Acid-base Disorders61

Metabolic Acidosis61

Concept61

Etiology and Pathogenesis61

Compensation63

Alteration of Metabolism and Function63

Respiratory Acidosis64

Concept64

Etiology and Pathogenesis64

Compensation65

Alteration of Metabolism and Function65

Metabolic Alkalosis66

Concept66

Etiology and Pathogenesis66

Compensation67

Alteration of Metabolism and Function67

Respiratory Alkalosis68

Concept68

Etiology and Pathogenesis68

Compensation68

Alteration of Metabolism and Function68

Mixed Acid-Base Disorders69

Metabolic Alkalosis and Metabolic Acidosis69

Metabolic Acidosis and Respiratory Alkalosis69

Metabolic Acidosis+Respiratory Acidosis70

Metabolic Alkalosis+Respiratory Alkalosis70

Metabolic Alkalosis+Respiratory Acidosis70

Triple Acid-base Disorders70

Diagnosis of Acid-base Disorders70

Case Presentation72

Chapter 4 Hypoxia74

Parameters of Blood Oxygen74

Partial Pressure of Oxygen(PO2)74

Oxygen Capacity(CO2max)74

Oxygen Content(CO2)74

Oxygen Saturation(SO2)75

P5076

Classification,Etiology and Pathogenesis of Hypoxia76

Hypotonic Hypoxia76

Causes76

Alterations of Blood Oxygen Parameters and the Mechanism of Tissue Hypoxia77

Cyanosis78

Hemic Hypoxia78

Causes78

Alterations of Blood Oxygen Parameters and Mechanism of Tissue Hypoxia79

Circulatory Hypoxia79

Causes79

Alterations of Blood Oxygen Parameters and Mechanism of Tissue Hypoxia79

Histogenous Hypoxia79

Causes79

Alterations of Blood Oxygen Parameters80

Alterations of Function and Metabolism80

Respiratory System80

Hyperventilation80

High Altitude Pulmonary Edema81

Respiratory Depression81

Circulatory System81

Increase of Cardiac Output81

Blood Flow Redistribution81

Pulmonary Vasoconstriction81

Capillary Proliferation82

Circulatory Failure82

Hemic System82

Increase of Erythrocytes82

Decrease of the Affinity of Hb for Oxygen82

Central Nervous System82

Cellular Alterations83

Cellular Adaptation83

Hypoxic Cell Damage83

Factors Affecting the Tolerance to Hypoxia83

Oxygen Consumption Rate83

Compensatory Ability of the Body84

Oxygen Therapy and Oxygen Intoxication84

Pulmonary Oxygen Intoxication84

Cerebral Oxygen Intoxication84

Case Presentation85

Chapter 5 Fever87

Regulation of Normal Body Temperature87

Etiology88

The Infectious Factors88

The Non-infectious Factors89

Pathogenesis89

Endogenous Pyrogens89

IL-1 Family89

IL-690

Tumor Necrosis Factor90

Interferons(IFNs)91

Macrophage Inflammatory Protein-1(MIP-1)91

Thermoregulation of Fever91

Thermoregulating Center91

The Routes of Peripheral Pyrogenic Signals into Thermoregulation Center92

Central Mediators of Fever93

Alterations of Metabolism and Function97

Pathophysiological Basis of Prevention and Treatment99

Case Presentation100

Chapter 6 Cell Signaling in Diseases102

Major Pathways for Cell Signaling103

G-Protein-Mediated Cell Signaling103

AC Pathway104

PLC β Pathway104

Tyrosine Kinase Mediated Signaling105

Receptor Tyrosine Protein Kinase(RTPK)Pathway105

Non RTPK Pathway106

Guanylyl Cyclase(GC)Mediated Signaling106

Dysfunction of Cell Signaling in Diseases106

Aberrant Signal Molecules in Diseases107

Aberrant Receptors in Diseases107

Aberrant G-proteins in Diseases108

Cholera109

Pertussis109

Pseudohypoparathyroidism(PHP)109

Acromegaly and Gigantism109

Aberrant Intracellular Signaling in Diseases109

Multiple Signaling Aberrations in Diseases110

Type 2 Diabetes Mellitus110

Cancers110

Relationship between Stimulants and Pathological Effects112

Pathophysiological Basis of Prevention and Treatment112

To Regulate the Level of Extracellular Molecules113

To Regulate the Structure and the Function of Receptors113

To Regulate the Level and Modifications of Intracellular Messenger Molecules and Transducers113

To Regulate the Level of Nuclear Transcription Factors113

Case Presentation114

Chapter 7 Cell Proliferation,Differentiation,Apoptosis and the Related Diseases116

Cell Proliferation and Diseases116

Cell Cycle and its Control117

Cell Cycle117

Cell Cycle Control System117

Specific Checkpoints in the Cell Cycle118

Control of Cell Proliferation by Extracellular Signals119

Control of Cell Proliferation by Gene Expression119

Deregulation of Cell Proliferation and Diseases119

Tumor120

Cardiac Hypertrophy121

Cell Differentiation and Diseases121

Control of Cell Differentiation121

Intracellular Regulators122

Extracellular Factors That Control Differentiation123

Differentiation Abnormalities124

Abnormal Differentiation in Embryonic Development124

Abnormal Differentiation in Tumors124

Cell Apoptosis and Diseases124

Inducers of Apoptosis125

Effectors and Regulators of Apoptosis125

Effectors of Apoptosis125

Regulators of Apoptosis125

The Biochemical Pathways in Apoptosis126

Abnormal Cell Apoptosis in Diseases127

Chapter 8 Stress and Stress-related Diseases131

Terminology of Stress131

Stress Responses133

Neuroendocrine Responses133

Locus Ceruleus(LC)-norepinephrine Neurons(NE)-sympathetic/Adrenal Medulla Axis133

Hypothalamus-pituitary-adrenal Cortex Axis(HPA)134

Other Hormones in Stress136

Molecular,Cellular and Humoral Stress Responses136

Stress-activated Protein Kinases(SAPKs)137

Acute Phase Proteins137

Heat Shock Proteins(HSP)139

Functional and Metabolic Responses141

Central Nervous System141

Immune System142

Cardiovascular System143

Digestive System143

Genito-urinary System144

Metabolism144

Stress-related Disease144

Stress Ulcer145

Pathogenesis145

Stress and Cardiovascular Diseases146

Stress and Endocrinous Disorders146

Stress-induced Disturbance in Growth-thyroid Function147

Stress-induced Disturbance in Gonadal Axis147

Stress and Psychosocial Disturbance-the PTSD147

Pathophysiological Basis of Prevention and Treatment for Stress Disorders148

Case Presentation148

Chapter 9 Coagulation-anticoagulation Balance and Disorders of Hemostatic System151

Overview of Hemostatic System151

Vasospasm151

Blood Coagulation151

Formation of the Platelet Plug152

Platelet Activation152

Platelet Adhesion152

Platelet Aggregation153

P1atelet Secretion153

Clot Dissolution(Fibrinolysis)154

Anticoagulation System154

Thrombomodulin(TM)-Protein C(PC)System154

Antithrombin Ⅲ(AT Ⅲ)155

Tissue Factor Pathway Inhibitor(TFPI)155

Roles of Endothelial Cells155

Disseminated Intravascular Coagulation156

Etiology157

Pathogenesis157

Tissue Factor and Systemic Activation of Coagulation157

Endothelial Lesion and Unbalance of Procoagulation and Anticoagulation158

Entrance of Procoagulant Substances to Blood158

B1ood Cells Damage158

Factors Influencing the Development of DIC159

Mononuclear Phagocyte System Dysfunction159

Liver Dysfunction159

Hypercoagulable State159

Microcirculation Dysfunction160

Clinical Classificayion of DIC160

Acute DIC160

Subacute DIC160

Chronic DIC160

Alterations of Metabolism and Function160

Bleeding160

Organ Dysfunction161

Shock162

Hemolytic Anemia162

Pathophysiological Basis of Prevention and Treatment162

Management of the Underlying Disorder162

Improving the Microcirculation162

Reconstructing the Balance of Coagulation and Fibrinolysis162

Case Presentation163

Chapter 10 Shock165

Etiology and Classification165

Hypovolemic Shock165

Cardiogenic Shock165

Infectious Shock165

Anaphylactic Shock166

Neurogenic Shock166

Traumatic Shock166

Pathogenesis166

Stages of Shock and Their Pathological Changes166

Ischemic Hypoxia Stage166

Stagnant Hypoxia Stage168

Organ Failure Stage170

Roles of Humoral Factors in Pathogenesis of Shock170

Catecholamine and Angiotensin170

Cytokines171

Adhesion Molecules172

Endothelium-derived Vasoactive Mediators172

Activation of Complement Cascade172

Lysosomal Enzymes172

Redox Imbalance173

Alterations of Metabolism and Function173

Neuroendocrine System173

Cardiovascular System174

Hematologic System174

Immune System174

Lung175

Kidney175

Gastrointestinal Tract176

Liver176

Metabolic Derangement176

Cellular Responses176

Pathophysiological Basis of Shock Prevention and Treatment177

Volume Replacement178

Application of Vasoactive Drugs178

Treatment of Acidosis178

Treatment of DIC or Organ Dysfunction(See Related Chapter)178

Multiple Organ Dysfunction Syndrome(MODS)178

Systemic Inflammatory Response Syndrome(SIRS)178

Compensatory Anti-inflammatory Response Syndrome(CARS)179

Mixed Antagonist Response Syndrome(MARS)180

Case Presentation181

Chapter 11 Ischemia-Reperfusion Injury184

Etiology of Ischemia-Reperfusion Injury184

Duration of Ischemia184

Dependency on Oxygen Supply184

Condition of Reperfusion184

Pathogenesis of Ischemia-Reperfusion Injury185

Injury of Free Radicals185

Generation of Free Radical185

Alterations Induced by Oxygen Free Radicals187

Calcium Overload188

Mechanism of Calcium Overload188

Alterations Induced by Calcium Overload189

Endothelial Injury and Neutrophil Activation191

Alterations of Metabolism and Function During Ischemia-Reperfusion Injury192

Myocardial Ischemia-Reperfusion Injury192

Reperfusion Arrhythmias192

Myocardial Stunning192

Influence of Reperfusion on Myocardium Metabolism193

Influence of Reperfusion on Ultrastructure of Myocardium193

Cerebral Ischemia-Reperfusion Injury194

Hepatic Ischemia-Reperfusion Injury194

Renal Ischemia-Reperfusion Injury195

Pathophysiological Basis of Prevention and Treatment for Ischemia-Reperfusion Injury195

Controlling Reperfusion Conditions195

Antioxidants and Free Radical Scavengers196

Inhibitors of Neutrophils Activation196

Calcium Antagonists or Calcium Channel Blocker196

Case Presentation197

Chapter 12 Heart Failure200

Etiology200

Causes200

Precipitating Factors201

Classification201

By the Side of Heart Involved201

By Degrees of Changes in Cardiac Output201

By Acute or Chronic Onset202

By Systolic or Diastolic Dysfunction202

By Severity and Stages202

Compensatory and Adaptive Response203

Activation of Neurohumoral System204

Activation of Sympathetic Nervous System204

Activation of Renin-angiotensin-aldosterone System204

Natriuretic Peptides204

Cytokines205

Functional Adjustment205

Increasing Heart Rate and Cardiac Contractility205

Increasing Cardiac Output by Frank-Starling Mechanism205

Myocardial Remodeling205

Extracardial Compensation206

Redistribution of Blood Flow206

Increase of Erythrocytes207

Increased Ability of Tissues to Utilize Oxygen207

Pathogenesis207

Injury and Rearrangement of Myocardium207

Disorders in Energy Metabolism208

Disorders in Energy Production208

Disorders in Energy Utilization208

Dysfunction of Excitation-Contraction Coupling208

Reduced Influx of Extracellular Ca2+208

Disorders of SR in Ca2+ Handling209

Dysfunction of Ca2+ Binding to Troponin209

Decreased Ventricular Compliance209

Asynergic Myocardial Contraction and Dilation210

Alterations of Metabolism and Function210

Low Output Syndrome210

Changes of Hemodynamic Parameters210

Ischemia of Organs211

Venous Congestion Syndrome211

Congestion of Systemic Circulation211

Congestion of Pulmonary Circulation211

Pathophysiological Basis of Prevention and Treatment212

Control and Removal of Causes and Precipitating Factors212

Improvement of Cardiac Pump Function213

Reducing Cardiac Preload and Afterload213

Improving Cardiac Contractility and Diastolic Properties213

Intervention of Myocardial Remodeling213

Promotion of Myocardial Growth and Replacement of Failing Heart213

Case Presentation214

Chapter 13 Respiratory Failure218

Etiology and Pathogenesis218

Ventilatory Disorder218

Restrictive Ventilatory Disorder218

Obstructive Ventilatory Disorder219

Diffusion Disorder220

Ventilation and Perfusion Imbalance221

Functional Shunt Caused by Local Hypoventilation222

Dead Space Like Ventilation Caused by Local Hypoperfusion222

Anatomic Shunt222

Acute Respiratory Failure and Chronic Respiratory Failure223

Pathogenesis of Acute RF in Acute Respiratory Distress Syndrome(ARDS)223

Pathogenesis of Chronic RF in Chronic Obstructive Pulmonary Disease(COPD)224

Alterations of Function and Metabolism224

Acid-base Imbalance and Electrolyte Imbalance224

Respiratory System224

Cardiovascular System225

Central Nervous System225

Pathophysiological Basis of Treatment226

Treating the Causes of Respiratory Failure226

Increasing PaO2226

Decreasing PaCO2226

Case Presentation227

Chapter 14 Hepatic Failure230

Etiology230

Hepatic Insufficiency230

Metabolic Disorders230

Carbohydrate Metabolic Disorders230

Lipid Metabolic Disorders231

Protein Metabolic Disorders231

Metabolic Disorders of Water and Electrolytes232

Hepatic Ascites232

Electrolytic Metabolic Disorders232

Disorders in Production of Bile Salts and Elimination of Bilirubin232

Disorders in Biochemical Transformation232

Impaired Kupffer Cells Function232

Hepatic Encephalopathy233

Etiology and Classification233

Pathogenesis234

Ammonia Intoxication234

False Neurotransmitters and Amino Acid Imbalance236

The Gamma-aminobutyric Acid Hypothesis238

Precipitating Factors of HE239

Gastrointestinal Bleeding239

Abuse of Sedatives and Narcotics240

Massive Paracentesis and Excessive Diuresis240

Infections240

Principles of Treatment240

Hepatorenal Syndrome241

Pathogenesis241

Stimulated Sympathetic Nervous System241

Activated Rennin-angiotensin-aldosterone System241

Increased Vasopressin Release241

Other Humoral Factors241

Principles of Treatment and Prevention243

Case Presentation244

Chapter 15 Renal Insufficiency247

Basic Tache of Pathogenesis for Renal Insufficiency247

Dysfunction of Glomerular Filtration248

Decrease of Renal Blood Flow249

Decrease of Glomerular Effective Filtration Pressure249

Decrease of Glomerular Capillary Surface Area249

Alterations of Permeability of Glomerular Filtration Member249

Renal Tubular Dysfunction249

Dysfunction of Proximal Convoluted Tubules250

Dysfunction of Henle's Loop250

Dysfunction of the Distal Convoluted Tubules and Collecting Ducts250

Renal Endocrine Dysfunction250

Renin-angiotensin-aldosterone System(RAAS)250

Erythropoietin(EPO)250

1α,25-dihydroxyvitamin D3(1,25-[OH]2D3)250

Kallikrein-kinin-prostaglandin-system(KKPGS)251

Parathyroid Hormone(PTH) and Gastrin251

Acute Renal Failure251

Etiology and Classification of ARF251

Prerenal ARF252

Intrarenal ARF252

Postrenal ARF252

Pathogenesis of ARF253

Glomerular Factors253

Renal Tubular Factors253

Renal Cellular Injury and Its Mechanisms255

Alterations of Metabolism and Function During ARF256

The Oliguric Stage256

The Polyuric Stage257

The Recovery Stage258

Pathophysiological Basis of Prevention and Treatment for ARF258

Chronic Renal Failure258

Etiology of CRF259

Progressive Stages of CRF259

Pathogenesis of CRF259

The Major Hypotheses on CRF259

Mechanism Responsible for the Loss of Nephron Function261

Alterations of Metabolism and Function During CRF263

Alteration of Urine263

Azotemia263

Water,Electrolytes and Acid-base Imbalance263

Renal Hypertension264

Renal Osteodystrophy265

Tendency to Hemorrhage265

Renal Anemia265

Uremia266

Pathogenesis of Uremia266

Retained Metabolic Products266

Overproduction of Counter-regulatory Hormones267

Underproduction of Renal Hormones267

Functional and Metabolic Alterations During Uremia267

Nervous System267

Digestive System267

Cardiovascular System267

Respiratory System268

Immune System268

Skin Changes(Dermatologic Abnormalities)268

Metabolic Disorders268

Pathophysiological Basis of Prevention and Treatment for CRF and Uremia269

Case Presentation270

Chapter 16 Brain Dysfunction277

Introduction277

Characteristics of Brain Structure,Metabolism and Function277

Characteristics of Brain Diseases277

Cognitive Disorders278

Structural Basis of Cognition278

Physiology of Cognition279

Major Manifestations of Cognitive Disorders279

Learning and Memory Disorders280

Aphasia280

Agonosia280

Apraxia280

Dementia280

Etiology and Pathogenesis of Cognitive Disorders281

Chronic Brain Damage281

Chronic Systemic Diseases284

Mental and Psychic Disorders285

Other Factors285

Principles for Treatment of Cognitive Disorders285

General Neuroprotective Treatments285

Maintenance of Normal Neurotransmitter Level286

Surgery286

Consciousness Disorder286

The Structural Basis of the Brain in Consciousness and Consciousness Disorders286

Dysfunction of Brain Stem Reticular Formation286

Dysfunction of Thalamus287

Dysfunction of Cerebral Cortex287

Major Manifestations in Consciousness Disorders287

Delirium287

Confusion287

Stupor287

Coma288

The Etiology and Pathogenesis of Consciousness Disorder288

Acute Brain Injury288

Acute Brain Intoxication288

Intracranial Extrusion and Destructive Lesion289

Systemic Disturbance Caused by Consciousness Disorder289

Respiratory Disorders290

Disturbance of Fluid-electrolyte and Acid-base Balance290

Circulation Dysfunction291

Others291

Principles of Prevention and Therapy291

Urgent Management291

Making A Definite Diagnosis as Soon as Possible291

Monitoring Vital Signs and Consciousness State291

Brain Protections291

Case Presentation292

Index295