THE SYLLABUS OF PATHOPHYSIOLOGY
Applicable Students: Six-year system oversea students in the department of
clinical medicine.
Class Hours: It takes 78 hours to study this course. The study of theory consists of
54 hours and the study of experimental skill consists of 24 hours.
Course Introduction:
Pathophysiology is an important medical basic subject that is concerned with the
changes in function and metabolism during disease states. It deals with the causes and
development of diseases, as well with the progression of pathology during the course of
the disease. Therefore, pathophysiology is a transitional bridge subject between basic
science and clinical medicine．In teaching and research, one comes to realize that both
basic and clinical sciences are united by pathophysiology.
The Basic Objectives
This course lets students grasp the concepts, etiology, pathogenesis and principles
of the pathophysiological process, as well as prevention and treatment.
Teaching Hours Distribution--Theoretical Part (54hours)
Chapter
Contents
Hours
Chapter 1
Conspectus of Disease
2
Chapter 2
Water and Electrolytes Balance and Imbalance
8
Chapter 3
Acid-based Balance and Imbalance
6
Chapter 4
Fever
4
Chapter 5
Stress
2
Chapter 6
Hypoxia
4
Chapter 7
Shock
4
Chapter 8
Disturbances of Hemostasis
4
Chapter 13
Heart Failure
6
Chapter 14
Respiratory Failure
5
1
Chapter 15
Hepatic Failure
3
Chapter 16
Renal Failure
6
Total
54
CHAPTER 1: CONSPECTUS OF DISEASE
[Objectives]
1. Grasp the definition and causes of diseases.
2. Get familiar with the characteristics and processes of diseases.
3. Comprehend the process and treatment of diseases.
[Contents]
1. Concept of disease: Learn the definition and characters of diseases, learn how to
recognize diseases.
2. Etiology of disease: Learn the extrinsic factors, intrinsic factors and predisposing
factors of diseases.
3. Pathogenesis of disease: Learn the neural, humoral and cellular mechanisms of
diseases; learn the damage and anti-damage of diseases learn the reverse of causeresult in the disease process.
4. The process and outcome of diseases.
CHAPTER 2: WATER AND ELECTROLYTES BALANCE AND
IMBALANCE
[Objectives]
1. Grasp the concept, etiology, mechanism and clinical characteristics of dehydration.
2. Grasp the concept, etiology, mechanism and characteristics of hypokalemia and
hyperkalemia.
3. Grasp the concept and mechanism of edema.
4. Get familiar with the definition and effect of water intoxication on the body and the
2
metabolism and the regulation of water and electrolytes.
5. Comprehend the disturbance of calcium and magnesium, treatment of water and
electrolytes disturbance.
[Contents]
1. Physiological review of dehydration: learn the concept, causes, characteristics and
effects on the body and the principles of treatment of hypotonic and hypertonic
dehydration.
2. Water intoxication
3. Edema, the exchange of plasma and interstitial fluid; the imbalance of exchange
between intra-vascular and extra-vascular fluid and the imbalance of exchange
between intra-body and extra-body fluid.
4.
The concept, causes, effects on the body and the principles of treatment of
hypokalemia and hyperkalemia.
CHAPTER 3: ACID-BASED BALANCE AND IMBALANCE
[Objectives]
1. Grasp the concept, etiology, mechanism, compensatory process and the effect of
simple acid-based imbalance.
2. Get familiar with the source and regulation of acid-based balance, the laboratory
parameters of acid-based balance and the concept, etiology and characteristics of
mixed acid-base imbalance.
3.
Comprehend the principles of treatment of acid-based imbalance.
[Contents]
1. Physiological review
2. The control of acid-based balance in the body: how to control acid-based balance,
including the roles of the buffer, lungs, kidneys and cells.
3. Laboratory parameters of acid. Based balance: the concept and significance of
pH, PCO 2 , SB, AB, BB, BE, AG.
3
4.
Type of acid-based balance: the concept, causes, effects on the body and the
principles of treatment of metabolic acidosis and respiratory acidosis, metabolic
alkalosis and respiratory alkalosis. The concept of mixed acid-based imbalance.
CHAPTER 4: FEVER
[Objectives]
1. Grasp the definition of fever, pyrogenic activators and endogenous pyrogens.
2. Grasp the etiology and pathogenesis of fever.
3. Get familiar with the functional and metabolic changes of fever.
4. Comprehend the principles of fever.
[Contents]
1. Revision of the normal body temperature; the definition of fever.
2. Etiology: exogenous pyrogen and non-microbial pyretic substances.
3. Pathogenesis
4. Stages and manifestations, alteration in the metabolism and functions.
5.
Management and treatment.
CHAPTER 5: STRESS
[Objectives]
1. Grasp the definition of stress, stressors, heat shock protein and acute phase protein.
2. Grasp the etiology, pathogenesis and functional metabolic alteration.
3. Get familiar with stress-related diseases.
4. Comprehend the prevention and principles of treatment.
[Contents]
1. Introduction: definition, etiology and pathogenesis of stress.
2. The definition of stressors and pathogenesis of stress response.
3. Alterations of metabolism and functions.
4. Stress and diseases.
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5. Management and treatment.
CHAPTER 6: HYPOXIA
[Objectives]
1. Grasp the concept of hypoxia.
2. Grasp the parameters of blood oxygen and causes of hypoxia.
3. Get familiar with the changes in the functions and the metabolism during hypoxia.
[Contents]
1. Overview of hypoxia.
2. Parameters of blood oxygen: PaO2/PvO2, CO2max, CaO2/CvO2, SaO2/SvO2, P50,
and O2 dissociation curve.
3. The classification, etiology and mechanisms of hypoxia.
4. Alterations of the metabolism and the functions in the body.
5. Pathophysiological basis of prevention and treatment.
CHAPTER 7: SHOCK
[Objectives]
1. Grasp the mechanism of shock including the changes of microcirculation.
2. Grasp the effects of shock on the body.
3. Get familiar with the classification and clinical manifestations of shock.
[Contents]
1. Introduction: the history, clinical manifestations and definition of shock.
2. Classification of shock.
3. Physiology of the microcirculation.
4. Pathogenesis of shock: the three stages of shock, including the stage of ischemic
anoxia, the stage of stagnant anoxia and the stage of microcirculation failure.
5. The effect of other humoral factors on the pathogenesis of shock.
6. The treatment of shock.
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CHAPTER 8: DISTURBANCES OF HEMOSTASIS
[Objectives]
1. Grasp the definition of DIC.
2. Grasp the severe effects of DIC on the body and the mechanism of bleeding.
3. Get familiar with the promoting causes and causes of DIC.
4. Comprehend the physiology of coagulation and fibrinolysis system.
[Contents]
1. Introduction: the history, clinical manifestation and definition of DIC.
2. Review the physiology of the coagulation and fibrinolysis system.
3. Etiology and pathogenesis: including the injury of endothelial cells, thromboplastin
in the circulation, the injury of blood cells and granular substances in the
circulation.
4. Promoting causes.
5. Stages and classification.
6. Pathological changes and clinical manifestation: hemorrhage, shock, embolism,
hemolytic anemia.
7. Laboratory tests and diagnosis and management and treatment.
CHAPTER 13: HEART FAILURE
[Objectives]
1. Grasp the mechanism of heart failure.
2. Grasp the mechanism of orthopnea and paroxysmal nocturnal dyspnea.
3. Get familiar with the mechanism of compensation during heart insufficiency.
4. Comprehend the classification and treatment principles.
[Contents]
1. Concept
2. Etiology: the causes including physical factors, cardiomyopathy and arrhythemia.
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3. Classification
4. Pathogenesis: the compensatory processes and decompensatory processes.
5. Effects on the body: the circulatory dysfunction, respiratory disorders, and GI
system, kidney damage during heart failure.
CHAPTER 14: RESPIRATORY FAILURE
[Objectives]
1. Grasp the etiology and mechanism of respiratory failure.
2. Grasp the mechanism of pulmonary encephalopathy.
3. Get familiar with the effects on the body during respiratory failure.
[Contents]
1. Concept: respiratory failure and respiratory insufficiency.
2. Causes: ventilation disorders, diseases affecting the respiratory membrane,
ventilation-perfusion imbalance.
3. Pathogenesis and clinical manifestation.
4. Laboratory measure.
CHAPTER 15: HEPATIC FAILURE
[Objectives]
1. Grasp the mechanism of hepatic encephalopathy.
2.
Get familiar with the causes of hepatic encephalopathy.
[Contents]
1. The physiological function of the liver.
2. Ultra-structure and function of hepatic cells.
3. Hepatic coma: the mechanism of hepatic encephalopathy, including ammonia
intoxication, false neurotransmitter formation, amino-acid imbalance and GABA
hypothesis.
4. Learn the principles of treatment.
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CHAPTER 16: RENAL FAILURE
[Objectives]
1. Grasp the etiology and pathogenesis of acute renal failure.
2. Grasp the changes on the body during the three stages of acute renal failure.
3. Get familiar with the causes and mechanism of chronic renal failure.
4. Comprehend the changes on the body during uremia.
[Contents]
1. Acute renal failure
(1) Causes: pre-renal pathology, intra-renal pathology and post-renal
pathology.
(2) Pathogenesis: renal hemodynamic alteration, glomerular structure changes,
abnormalities in renal tubules.
(3) Clinical process: oliguric phase, diuretic phase, recovery phase.
2. Chronic renal failure
(1) Pathogenesis: intact nephron hypothesis, trade-off hypothesis, high metabolic
rate of tubules.
(2) Manifestation: water-electrolytes and acid-based imbalance, metabolic acidosis,
azotemia,
osteodystrophy,
anemia
and
hemorrhagic
tendency,
renal
hypertension.
3. Uremia
(1) Pathogenesis: retention of toxic metabolic wastes, nutrient depletion or
impaired synthesis, enhanced synthesis of bioactive compounds.
(2) Manifestation: biochemical disturbances, functional disturbances.
(3) Principles of treatment.
Teaching plan--laboratory practices (24 hours)
No.
Contents
Hours
8
1
Experimental edema in rabbits
4
2
Acid-based imbalance in rabbits
4
3
Hypoxia in mice
4
4
Acute whole heart failure in toads
4
5
Hemorrhagic shock and treatment in rabbits
8
Total
24
NO1. EXPERIMENTAL EDEMA IN RABBITS
[Objectives]
1. Reproduce a pulmonary edema in an animal
2. Grasp the manifestations and mechanisms of pulmonary edema.
[Animal]: Rabbit
[Contents]
1. Local anesthesia.
2. Insert a cannula into the trachea and a venous catheter into the external jugular
superficial vein respectively.
3. Transfuse an excess of normal saline and epinephrine.
4. Observe the characteristics of breath sounds at different stages of the edema.
NO2. ACID-BASED IMBALANCE IN RABBITS
[Objectives]
1. Reproduce an acidosis and alkalosis in an animal.
2. Analyze the alteration in blood gas and the manifestations and mechanisms of acidbase imbalance.
[Animal]: Rabbit
[Contents]
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1. General anesthesia.
2. Insert an arterial catheter into the common carotid artery.
3. Transfuse an excess of lactic acid and treat it with sodium bicarbonate.
4. Observe the characteristics of blood gas and manifestations.
NO3. HYPOXIA IN MICE
[Objectives]
1. Reproduce hypotonic, hemic and histogenous hypoxia in an animal.
2. Observe the clinical manifestations of hypoxia and cyanosis.
3. Understand the manifestations and mechanisms of each type of hypoxia.
4. Master how to treat carbon monoxide poisoning.
[Animal]: Mouse
[Contents]
1. Review the method of holding a mouse.
2. Reproduce hypotonic hypoxia in an animal.
3. Observe the manifestations of CO poisoning and how to provide treatment.
4. Reproduce nitrite poisoning hypoxia and observe the manifestations.
5.
Reproduce KCN poisoning hypoxia and observe the manifestations.
NO4. ACUTE WHOLE HEART FAILURE IN TOADS
[Objectives]
1. Reproduce acute whole heart failure in an animal through CdSO4 perfusion.
2. Analyze the mechanism of an increased preload on the cardiac function during
normal conditions, intoxication and treatment of norepinephrine.
[Animal]: Toad
[Contents]
1. Prepare the perfusion sample for the toad’s heart.
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2. Observe the effect of increased preload on the cardiac function during normal
condition.
3. Observe the effect of increased preload on the cardiac function during intoxication.
4. Observe the effect of increased preload on the cardiac function during treatment.
NO5. HEMORRHAGIC SHOCK AND TREATMENT IN
RABBITS
[Objectives]
1. Reproduce hemorrhagic shock on an animal.
2. Observe the main changes in the body during shock and its pathogenesis.
3. Observe the normal mesenteric microcirculation and the changes after shock.
4. The pathogenesis and principles for treatment of shock.
[Animal]: Rabbit
[Contents]
1. Apply general anesthesia.
2. Shave off the hair and make a median incision in the neck with a length of about
5cm down from the thyroid cartilage.
3. Dissect the external jugular vein and common carotid artery.
4. Insert and fix an arterial cannula and a venous cannula.
5. Observe the normal BP and breathing.
6. Let blood from common carotid artery and maintain mean arterial pressure at
40mmHg for 30 min.
REFERENCES
1. Lee-Ellen C, Copstead, Perspectives on Pathophysiology, 2000
2. Sue E. Huether, Understanding Pathophysiology, 2nd Edition, 1997
3. Barbara L, Bullock, Pathophysiology – Adaptations and Alterations in Function, 4th
Edition, 1999
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4. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology, 1st Edition, Science
Publishing House, 2006
5. Wang Jianzhi, Jin Huining, Pathophysiology, 1st Edition, People’s medical
Publishing House, 2005.
6. Kong Xianshou, Contemporary Pathophysiology, Shanghai, 1993
7. Intensive Care Med., [J]
8. Am J Physiol., [J]
9. New Engl J Med., [J]
10. Shock, [J]
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