Faculty of Medicine, Charles University
Department of Pathophysiology
Syllabus
Pathological physiology – characteristics and significancy of the discipline
Pathophysiology is a scientific discipline which is engaged with general
and special laws of the origin, course and termination of the processes of diseases.
It studies deviations from normal functions of the organism at molecular, cellular
level as well as of individual organs and of the organism as a whole. In the general
part it is engaged with influences of pathogenic stimuli, with disturbances of
adaptation, regulation and defensive mechanisms and with the reactions of the
whole organism. In the special part it studies changes and processes in individual
diseases and functional systems. The main gain of knowledge is due to clinical
observation and due to experiments. Experiments with animals or with alternative
methods enable to create models of pathological processes at different stages of
their evolution. The analysis of partial results and their subsequent synthesis help
to understand the mechanisms of the origin and of the course of the disease. Thus
also the basis for the prevention and for the therapy is given.
General pathophysiology
Importance and table of contents of the pathophysiology.
Disease - definition and stages - course - diagnosis - therapy - prognosis.
Models of pathological conditions. Principles of experimental work (ethical and
legislative problems resulting from an experiments on the aboratory animals).
Alternative methods.
Etiology and pathogenesis (definition - historical development - pathological process feedback control - importance of neuronal and humoral regulation).
Exogenous (extrinsic ) etiological factors (basic classification: physical, chemical,
biological, psychic and social; mechanical, thermic, el. current, radiation, atmospheric
pressure, kinetosis, noise; modification of final effect of drug on the organism; bacteria,
viruses, parasites, fungi - exotoxins and endotoxins; nutrition, hygiene, habitation,
personal intercorses).
Endogenous (intrinsic) etiological factors
Reactivity, constitutional typology
Chromosomal heredity - disorders (autosomal dominant, recessive, incompletely
dominant, codominant, X-linked, polygenic, heterogenic)
Mitochondrial heredity
Inborn errors of metabolism - sacharides: pentosuria, fructosuria, galactosemia,
glycogenoses; mucopolysacharidoses; sphingolipidoses; aminoacids: phenylketonuria,
alkaptonuria, albinism, homocystinuria; proteins: analbuminaemia,
agamaglobulinaemia; different others: Lesch-Nyhan syndrome, familial
hypercholesterolemia, cystic fibrosis
Chromosomal abnormalities - syndromes: Down´s, Edward´ s, Patau´s, cat-cray,
Klinefelter´s, Turner´s, fragile X
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Prenatal diagnosis (amniocentesis, ultrasound, fetoscopy) - pharmacogenetics genealogy - eugenics - genetic engineering - reproductive technology.
Pathophysiology of growth and development ( cellular mechanisms, fylogeny and
ontogeny, altricial and praecocial type, brain growth spurt, main influences - „nature or
nurture“; prenatal period - embryo, fetus; gametopathies. blastopathies, embryopathies,
congenital malformations; perinatal complications; postnatal development - main
periods, their characteristics; critical developmental periods, secular trend; relationship
between morphology and function; signs of full period of pregnancy - disturbances;
importance of nutrition, emotional and sensoric stimulation - syndrome of deprivation)
Pathophysiology of senescence (gerontology, geriatry; demographic senescence,
theories of senescence: programmed genetical mechanisms, metabolic and immune
disorders, changes og neurohomoral regulation; dynamic of senescence - social aspects
- prevention - pharmacogerontology)
Extinction of life, death (causes and mechanisms, clinical and biological death; brain
death - criteria; persistent vegetative state, locked-in syndrome; philosophical,
theological and social aspects; euthanasia, disthanasia; legal state (consequences) in
Czech Republic and in the world)
Pathophysiology of immunity (interdisciplinary issue, basic division - congenital,
acquired, disorders; inflammation-signs, mediators, immunodeficiency - congenital and
acquired, AIDS, disorders of humoral and cellular mechanisms, allergy and
anaphylaxis; auoimmune diseases, transplantation)
Patophysiology of stress (history-H.selye, J.Charvát, V.Schreiber, definition syndrome of adaptation, stressor, eustress, distress; relationship between stress and
shock, stress reaction-importance of CNS; humoral mechanism-role of hypothalamus,
hypophysis, adrenal gland; relationship between stress and pathogenesis of diseasespsychosomatic disorders, disturbance of immunity)
Pathophysiology of pain (dual role in health and disease; causes-receptors, nerve fibers,
pathway; role of peptides and neurotransmitters; gate theory of pain, types of painsuperficial, deep, ischemic, reffered, phantom, thalamic; control mechanismsendogenous opioids, transmitters, RF, psychic; experimental models; principles of
treatment)
Pathophysiology of tumours (theory og cancerogenesis-physical, chemical, viral; role
of heredity-protooncogenes, oncogenes, tumours-supressed genes, reverse
transcriptase; multiple primary cancers; metabolism og tumour-malignant cells, cancer
tests-biological markers-antigens. hormones, enzymes; principles of cancer therapysurgical, irradiation, chemotherapy)
Pathophysiology of blood
Changes of blood volume: normo-, hypo- and hypervolemia-normocythaemic, oligoand polycythaemic; causes of hypovolemia-renal and extrarenal (bleeding, burns, loss
of fluids from GIT, thermic changes, endocrine disorders); hypervolemia-temperature,
muscle work, endocrinopathies, pregnancy)
Changes of plasma composition: disoders of protein spectrum, changes of organic and
anorganic substances
Pathophysiology of red blood cells: anaemias (classification-normo-, micro,macrocytic, normo- and hypochromic; primary /disorders of bone marrow, liver,
kidney, malnutrition -vitamines, iron, proteins/ and secondary /haemorhagic,
haemolytic- inborn, attained/); polycythaemias- primary and secondary; blood groups,
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tranfusion, incompatibility
Pathophysiology of leukocytes: changes of number- leukopenia, granulocytopenia,
agranulocytosis, leukocytosis (physiological and pathological); disorders of functions
(syndrome of lazy leukocytes, phagocytosis inhibition, chronic septic granulomatosis);
leukaemias - classification, etiology, pathophysiological view; lymphomas; specific
immunodeficient states connecting with leukocytes/ lymphocytes
Pathophysiology of thrombocytes, coagulation: haemorhagic diseases-causes: inborn
and atteined disorders of thrombocytes (essential thrombocytopenia, thrombasthenia,
drugs, antibodies, myeloproliferation), plasma factors (haemophilia, hypovitaminosis
K, tumours), vascular defects (hereditary haemorhagic teleangiectasis, hypovitaminosis
C, purpuras)
Pathophysiology of circulation
Peripheral circulation - active and passive hyperemia; oedema - changes of hydrostatic,
osmotic and oncotic pressure; hemorrhage - causes, classification; thrombosis - venous,
arterial- course and consequences; embolism - classification (peripheral, central,
paradoxical), types (thrombi, gass, lipids); cyanosis - causes, division (peripheral,
central); atherosclerosis - modern opinion about etiology, theory of endothelial
dysfunction (lipids, proteins, free radicals), pathogenesis, risc factors and complications
General disorders of regulation. Shock - definition, main classification (hypovolemic,
cardiogenic, vascular), haemodynamic changes according to cause, stages
(compensatory, decompensatory); collapse /syncope/ - causes, types
Cardias insufficiency (congective heart failure): etioplohy, pathogenic changes.
compensatory mechanisms, acute, chronic, of left or right part of heart; asthma
cardiale, cor pulmonale - mechanism of origin
Congenital and aquired heart defects: functional classification (non cyanotic,
cyanotic); summary of main valvular diseases and other deffects, hemodynamic
consequences (changes of blood pressure, pulse)
Ischemic heart disease: etiology, risc factors; pathogenesis- division according to
clinical importance: acute forms (instable angina pectoris, acute myocardial infarction
/Q-form, non-Q/, sudden death), chronic forms (angina pectoris, Prinzmetal type, X
syndrome); mechanism of subendocardial and epicardial ischemia - main ECG signs;
diagnostic possibilities, differential diagnosis, complications
Disorders of cardiac rhytm - arrhytmias /dysrhytmias/ - main division (disturbance of
impulse origin, conduction or combination of both); summary of different types,
principles of origin, ECG signs, hemodynamic consequences, complications
Hypertension: classification-systolic, diastolic; primary /essential/, secondary; mosaic
theory, influence of neuronal and humoral mechanisms; accelerated, malignant
hypertension; pulmonary hypertension
Pathophysiology of respiration
Definition of respiration, division of respiration (external, internal)
Basic mechanisms of respiration: ventilation, difusion, perfusion.
Protective breathing reflexes.
Patofyziology of symptoms of respiratory diseases: cough, chest pain.
Dyspnea, ortopnea, paroxysmal nocturnal dyspnea.
Pathophysiology of external breathing: increased pressure of gases, caisson disease,
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mountain and altitude disease, stenoses and obstacles in respiratory airways
Abnormal gas exchange: hypoxia and types, acidosis, alkalosis, asfyxia.
Internal breathing.
Pathophysiology of pleural cavity, pneumothorax.
Pathophysiology of respiratory regulation: apnea, periodic breathing.
Pathophysiology of respiratory center, gasping, paralysis of respiratory muscles.
Lung volumes and capacities.
Patofyziology of obstructive and restrictive respiratory diseases.
Patofyziology of asthma bronchiale.
ARDS – respiratory distress syndrom.
Sleep apnea syndrom.
Patofyziology of pneumonia and carcinoma of lungs.
Pathophysiology of digestion and resorption
Pathophysiology of oral food processing (defects of salivation). Sjőgren`s syndrom.
Disorders of esophageal function. Dysphagia. Achalasia. Diaphragmatic hernia.
Pathophysiology of stomach. Disorders of secretion and motility.
Nausea and vomiting.
Ulcer disease of stomach and duodenum – etiologic factors.
Disorders of motility and secretion of small and thick intestine.
Syndrom of irritable intestine.
Ileus.
Dyspepsia (fermental and putrefactive).
Obstipation (causes, results).
Diarrhea (causes, results).
Defects of resorption.
Morbus Crohn.
Collitis ulcerosa.
Bleeding in digestive tract (causes, results, detection).
Colorectal carcinoma – etiology and occurance.
Pathophysiology of the liver
Experimental liver elimination (Eck‘s fistula etc.)
Disorders of liver function (funtional tests of liver)
Hepatitis – viral hepatitis (A, B, C, D, E, F, G)
autoimmune hepatitis (1, 2a, 2b, 3)
Hepatic failure – acute
chronic
Hepatic cirrhosis (causes, types, pathophysiology)
Portal hypertension, ascites
Hepatic encephalopathy
Hepatorenal syndrome
Jaundice – prehepatic jaundice
intrahepatic jaundice
posthepatic jaundice
Patophysiology of bilirubin metabolism
Disorders of the gallbladder function-
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cholelithiasis
cholecystitis
Pathophysiology of metabolism
Disorders of protein metabolism. Pathological proteins. Disorders of nitrogen balance.
Disorders of lipid metabolism. Disorders of lipid degradation and resorption.
Familiar hyperlipoproteinémia.
Pathophysiology of cholesterol – HDL, LDL.
Disorders of glycide metabolism. Hyperglycemia, hypoglycemia, glycemic curve,
glycosuria, glycogenesis.
Abnormalitis of glucose tolerance.
Diabetes mellitus – etiology and types. Steroid and gestation diabetes.
Effects of insulin and glucagon.
Diagnostic criteria of DM.
Diet, peroral antidiabetic drugs, terapy of insulin. Somogi`s effect.
Insulin resistance - Reaven`s syndrom.
Acute complications of DM – diabetic coma, hypoglycemic shock.
Chronic complications of DM – angiopathy, neuropathy, retinopathy and nefropathy.
Disorders of metabolism of mineral substances and water. Dehydration. Edema.
Disorders of metabolism of Na, Cl, K, Ca, P, Fe, Mg and trace elements.
Disorders of vitamin metabolism. Hypovitaminoses. Hypervitaminoses.
Nutrition and optimal composition.
Disturbances of energetical metabolism. Changes of the basal metabolism.
Defect of nutrition – malnutrition. Kwashiorkor. Mental anorexia.
Obesity – etiology and theraphy. Bulimia.
Pathophysiology of kidneys and urinary system
Disorders of glomerulal filtration
Disorders of proximal, distal tubules and loop of Henle
Pathophysiology of hormonal regulation of renal function
Acute renal failure
Chronic renal failure – metabolic alterations due to uraemia
pathophysilogy of symptoms in uraemia
consequences of alterations occuring in chronic
renal failure
Methods of renal substitution
Patogenesis of renal disorders –
immunne mechansms
ischemia of
kidneys
disorders of filtration
disorders of coagulation
toxic disorders
infection of kidneys
obstruction of urinary tract
inborn disorders
Infections of the urinary tract - cystitis
pyelonephritis
urethritis
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prostatitis
papillary necrosis
Urolithiasis (types, causes)
Urinary concentration and dilution, clearance
Pathophysiology of endocrine system
Hypothalamic-hypophyseal system – liberins, statins
Pathophysiology of hypothalamic-neurohypophyseal system
hypofunction of hypothalamo-hypophyseal system ( central diabetes insipidus etc.)
hypofunction of hypothalamo-hypophyseal system (Schwartz-Bartter‘s syndrome)
Pathophysiology of hypothalamic-adenohypophyseal system (giantism, nanism,
acromegaly, Cushing‘s disease, Simond‘s disease)
Pathophysiology of thyroid gland
pathophysiology of the regulation of thyroid gland
autoimmunne diseases of thyroid gland
iodine deficiency
thyroid gland during pregnancy and lactation
hypothyroidism
hyperthyroidism
Pathophysiology of parathyroid glands
hypoparathyroidism (tetany,laryngospasm etc.)
pseudohypoparathyroidism – unresponsiveness to PTH
hyperparathyroidism (primary, secondary)
Pathophysiology of the adrenal cortex
hyperfunction of the adrenal cortex (Cushing‘s syndrome, Conn‘s syndrome, adrenal
virilization)
hypofunction of the adrenal cortex ( Addison‘s disease)
Pathophysiology of adrenal medulla
pheochromocytoma
Endocrine disorders of gonads
endocrine disorders of the ovaries (ovarian endocrine hypo- and hyperfunction,
primary, central)
endocrine disorders of the testes ( hypo- and hypersecretion of testicular hormones –
primary, central
endocrine disorders in pregnancy
Pathophysiology of the endocrine pancreas
Diabetes mellitus: IDDM
NIDDM
Malnutrition-related DM
DM associated with other diseases and syndromas
Impaired glucose tolerance
Gestational DM
Complication of DM (coma, angiopathy,nephropathy, retinopathy
Nervous system
Functional and structural characteristics of the nervous system in health and disease
Survey of basic neuropathological terms -iritative or involution defects
Normal and pathological base of the synaptic processes
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Neurotransmitters, receptors, ionic channels, subcellular factors in pathophysiology of
neural transmission
Neuromuscular transmission - time factor during stimulation: chronaxy, reobasis,
lability
Myastenia gravis – pathophysiological mechanisms
Functional configuration of NS, reflexes, pathological dominancy, parabiosis.
Functional and organic lesions of CNS. Normal and pathological metabolism of CNS
(liquor).
Barrier mechanisms of the brain and its importance in normal and pathological states
Brain edema – complication and pathogenetical factor of many pathological states
Mitochondrial dysfunction and pathophysiology of nervous disorders
Neurochemical base of the pathophysiology of trauma, excitotoxicity
Nervous degeneration and regeneration, functional pathophysiological consequences
Evolution mechanisms of NS, genetically determined diseases of NS
Pathophysiology of the peripheral nervous system:
A. Defects of afferent nerves, involution, irritation, disorders of sensation
B. Defects of efferent nerves:
involution - (peripheral paralysis – paralysis of muscles, atonia, hypotonia,
involution of reflexes, muscular atrophy
irritation – myoclonia, fascicular twich, fibrilation
Pathophysiology of the vegetative nerves: Chemical transmission in the autonomic
nervous system . Vegetative reflexes – vasomotoric disorders (angiospastic neurosis,
Raynaud´s disease, angioneurotic edema, dermographism).
Pathophysiology of spinal cord
Spinal segmental disorders:
A. Sensitive: radicular, posterior horns, gray commissure
B. Motor
C. Vegetative
Defects of spinal columns (spinal ataxia, dissociation of sensation, areflexia)
Pathophysiology of the brain stem
Pathophysiology of medulla oblongata - syndrome of bulbar paralysis, syndrome of
pseudobulbar paralysis, breathing center and another vegetative center
Pathophysiology of pons Varoli
Pathophysiology of reticular formation
Functional importance of RF. Descendent inhibitory and facilitory system decerebration rigidity. Ascendent impact (reticulo - cortical relationships).
Pathophysiology of the midbrain
Involution defects of oculomotor nerves nuclei, nuclei tegmenti, pedunculi
cross syndromes
Pathophysiology of the cerebellum
Connections and functions of paleocerebellum and neocerebellum. Involution and
iritation syndrome. Cerebellar ataxia.
Pathophysiology of the thalamus
Symptomatology and pathophysiological mechanisms of defects of the thalamus in
efferent fuctions. Thalamic syndrome.
Pathophysiology of the hypothalamus
Food and fluid intake, sexual function, hormonal function, thermoregulation, fever,
vegetative nervous system control
Pathophysiology of motor dysfunction:
Defect of efferent functions - pyramide, extrapyramide (plegia, cerebellar ataxia,
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hypokinesis, hyperkinesis)
Defect of afferent functions (spinal ataxia, vestibular ataxia)
Methods of research and examination of neural functions
Reflexes examination, examination of motor functions, sensory perception
examination, stimulative methods.
Modern visualizing methods of the CNS
Thermography, sonography, X-ray examination, computer tomography, scintigraphy,
magnetic resonance imaging (MRI), brain mapping, positron emission tomography
Electrophysiological manifestation of the brain functions – normal and pathological.
Macroelectrophysiological recording methods: EEG, ERP (EP)
Microeletrophysiological methods: unit activity, voltage clamp, patch clamp
Stereotaxis, radioneurosurgery - importance in the therapy and the research
Pathophysiology of the higher nervous activity (protective inhibition, neuroses,
corticovisceral-psychosomatic relationships, psycho-neuro-immuno-endokrine
relationships)
Pathophysiology of behaviour. Examination of behavioral and psychic functions
Typology of the nervous system and pathology
Pathophysiology of emotions and instincts
Physiology and pathophysiology of sleep. Biological rhythms.
Pathophysiology of learning and memory
Pathophysiology of visual analyzer and tract
Pathophysiology of auditory analyzer and tract
Pathophysiology of vestibular analyzer
Pathophysiology of proprioception
Pathophysiology of smell and taste analyzer
Pathophysiology of somatosensory reception (types)
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