四川大学华西医学院《病理生理学》Ⅳ --教学大纲

《病理生理学》课程教学大纲课程简介一、课程简介病理生理学是研究疾病发生、发展和转归的规律及其机制的科学。

病理生理学是联系基础医学与临床医学的“桥梁”，也是临床医学的一部分。

学习的目的是了解疾病的发生发展的一般规律与机制，达到对疾病本质的认识。

病理生理学作为一门医学基础理论课程，一方面通过科学研究来探讨和揭示人类疾病发生、发展和转归的机制，提高疾病的防治水平；另一方面，通过课程学习，学生能够正确理解和掌握疾病的概念、病因学和发病学的一般规律，熟悉、掌握人体患病时出现的功能与代谢的变化和基本机制，并由此提高学生独立分析、思考和解决问题的能力。

病理生理学分为总论、基本病理过程和各系统器官病理生理学三个部分。

总论主要介绍疾病的概念、疾病发生发展中的普遍规律；基本病理过程主要讨论多种疾病中可能出现的共同的成套的功能、代谢和结构的变化；各系统器官病理生理学是指机体各个系统的许多疾病在发展过程中可能出现的一些常见的共同的病理变化。

本大纲适合于护理专科、口腔医学专科、乡村医学专科及医学检验专业。

本大纲根据陈国强主编《病理生理学》上海科学技术出版社，2004。

主要参考书：金惠铭主编《病理生理学》第六版人民卫生出版社2004二、总体要求通过本课程学习，要求学生能够：1．能够正确理解和掌握疾病的概念、病因学和发病学的一般规律，熟悉、掌握人体患病时出现的功能与代谢的变化和基本机制。

2．做到理论知识与临床实践紧密结合，并能应用于临床。

3．培养良好的学习风气，提高学生分析问题和解决问题的能力。

四、考核要求依据掌握和熟悉二个层次，记忆、解释、分析和应用进行考核。

理论考核为主：题型为：1.名词解释，2.是非题，3.填空题，4.单选题，5.问答题（含分析题）。

第一章绪论、疾病概论学习目的和要求通过本章学习，掌握：病理生理学的学科性质；健康、疾病、病理过程、病理状态、病因、条件、诱因、死亡和脑死亡等基本概念；疾病发生的条件和基本机制；疾病的发生与发展的一般规律和转归。

《病理生理学》教学大纲授课对象：探讨生总学时数：36 学时第一章细胞信号转导异样与疾病【目的要求】1.驾驭细胞信号转导的概念及途径；2.驾驭受体异样的信号转导异样；3.熟识 G 蛋白异样在疾病中作用；4.熟识多环节细胞信号转导异样与疾病的关系；5.了解细胞内信号转导异样与疾病的关系；6.了解细胞信号转导调控与疾病防治措施。

【教学内容】6 学时第一节细胞信号转导系统概述一、传导的基本过程和机制1.接受和转导（通过配体调整；通过 G 蛋白调整；通过可逆磷酸化调整）信号对靶蛋白的调整。

2.膜受体介导的信号转导通路举例（通过刺激型 G 蛋白（Gs），激活腺苷酸环化酶（AC），并引发 cAMP-PKA 通路；通过抑制型 G 蛋白（Gi），抑制 AC 活性，导致 cAMP 水平降低，导致与Gs 相反的效应通过 Gq 蛋白，激活磷脂酶C（PLCβ），产生双信使 DAG 和IP3；G 蛋白-其他磷脂酶途径激活 MAPK 家族成员的信号通路PI-3K-PKB 通路离子通道途径）二、细胞信号转导系统的调整受体数量的调整受体亲和力的调整其次节信号转导异样的缘由和机制一、信号转导异样的缘由生物学因素；理化因素；遗传因素（信号转导蛋白数量变更；信号转导蛋白功能变更—失活性突变和功能获得性突变）；免疫学因素（受体抗体的产生缘由和机制；抗受体抗体的类型—刺激型抗体和阻断型抗体）；内环境因素。

二、信号转导异样的发生环节第三节细胞信号转导异样与疾病一、受体、信号转导障碍与疾病雄激素受体缺陷与雄激素反抗征（男性假两性畸形；特发性无精症和少精症；延髓脊髓性肌萎缩）；胰岛素受体与胰岛素反抗性糖尿病。

二、受体、信号转导过度激活与疾病(生长激素过多)三、多个环节的信号转导异样与疾病1.肿瘤（促细胞增殖的信号转导过强—生长因子产生增多；受体的变更，某些生长因子受体表达异样增多和突变使受体组成型激活；细胞内信号转导蛋白的变更。

抑制细胞增殖的信号转导过弱）。

《病理生理学》教学大纲一、课程基本信息课程编码：50128420课程名称：病理生理学Ⅳ课程英文名称：PATHOPHYSIOLOGY课程性质：基础课授课对象：药学、卫生检验、卫生管理、健康保险等学时数：34学时学分数：2学分二、教学目的及要求：病理生理学是医学教育的一门主干学科，是医务人员必须掌握的一门基础医学知识。

病理生理学主要探讨疾病发生、发展的规律和机制，对这些规律和机制的深入认识不但有助于学生深入认识疾病，而且，由于近年来对疾病发生机制研究的飞速进展，病理生理学的内容更成为医学相关专业的学生和从业者跟上这种进展步伐的重要基础。

学好病理生理学将显著拓宽医学生的视野，增强他们的后劲。

病理生理学又是一门与多学科密切相关的桥梁性学科。

它不仅与解剖学、组织学、遗传学、免疫学、生理学、生物化学、病理学等密切相关，而且与临床各科亦密切相关。

病理生理学是连接基础医学与临床医学的一门过渡性学科。

三、教学内容：第一章绪论----------------------------------------------------------------------------------2第二章疾病概论----------------------------------------------------------------------------2第三章水、电解质代谢紊乱--------------------------------------------------------------2第四章酸碱平衡和酸碱平衡紊乱--------------------------------------------------------4第五章缺氧-----------------------------------------------------------------------------------5第六章发热-----------------------------------------------------------------------------------6第七章应激-----------------------------------------------------------------------------------6第八章休克-----------------------------------------------------------------------------------7第九章弥散性血管内凝血-----------------------------------------------------------------7第十章缺血-再灌注损伤-------------------------------------------------------------------8第十一章细胞信号转导与疾病------------------------------------------------------------8第十二章细胞凋亡与疾病------------------------------------------------------------------8第十三章心功能不全--------------------------------------------------------------------------8第十四章呼吸功能不全-----------------------------------------------------------------------9第十五章肝功能不全-------------------------------------------------------------------------10第十六章肾功能不全-------------------------------------------------------------------------11第十七章多器官功能障碍和衰竭----------------------------------------------------------12第一章绪论、疾病概论第一节绪论了解：病理生理学的任务熟悉：病理生理学内容：①疾病概论；②基本病理过程；③各系统病理生理学。

《病理生理学》教学大纲一、课程基本信息课程编码：50128330课程名称：病理生理学Ⅰ课程英文名称：PATHOPHYSIOLOGY课程性质：基础课授课对象：七、八年制医学生学时数：54学时学分数： 3 学分二、教学目的及要求：Pathophysiology is a interdisciplinary course which has close relationship with many other medical disciplines, such as physiology, biochemistry, immunology, pathology, anatomy, histology and clinical medicines as well, it is a bridge between the basic medical sciences and clinical medicines.This course is intended to introduce the basic knowledge about disease entities, what we presently understand regarding the etiology, pathogenic mechanisms, impairment and adaptation of metabolism and organ’s function. The emphasis is put on the mechanisms of pathogenesis and mechanisms resulting in metabolism and function alterations. Included is essential background information on most important and prevailingpathologic processes and diseases syndrome.“master”is the stresses of lecture, which is necessary for students, others is the comprehensive contents, which is also encouraged for students. Some chapters and contents in the textbook do not included in this outline because of a limited lecture hours for this course, these contents are also encouraged for students to study on one’s own, which, however, will not be included in the final exam.三、教学内容：Chapter One introduction of pathophysiology【AIM】master：Concept of Pathophysiology, etiology and pathogenesiscomprehensive：the mechanism of diseasethe changes within the body hat result from diseases and its mechanisms.【CONTENT】General Concept of Pathophysiology: comprehensivethe causes of disease -- etiologythe mechanism of disease -- the pathogenesis, emphasis on metabolism and function.the changes within the body that result from diseases and its mechanisms.Chapter Two General Introduction to Disease【AIM】master：Concept of disease , health , Pathological process, Etiological factors; Outcomeof Disease; Concept of Brain death and current concept of death.comprehensive: Predisposing factors, Precipitating factor; Development of Disease, 【CONTENT】1.Concept:Health: state of complete well-being in some and psyche.Disease: an abnormal life process under actions of pathogenic cause with disturbances of "homeostasis".Pathological process: refer to a process in which some common ,regular alterations of function ,metabolism and structure take place in many difference diseases. eg. Fever, shock ,edema etc.2.Etiology(1). Etiological factors: the direct cause:(2). Predisposing factors:The factors that influences the susceptibility or resistance to diseases.(3). Precipitating factorThe factor that promote, intensify the disease attack.3.Development of Disease:(1). General rulesa. Damage and Antidamage Responsesb. Interchange of Cause-Effectc. Locus and Whole(2) Basic Mechanisms4. Outcome of Disease:(1) Recovery: complete, incomplete(2)Death:①current concept of death: heart and breath stop forever over intense resuscitation②Brain death:the functions of cerebrum and brain stem stop foreverChapter Three Disorder of Water and Electrolytes Metabolism 【AIM】master：Regulation of water and sodium balance; classification of Disorder of water and sodium; concept and effect of hypotonic dehydration, Hypertonic dehydration and Isotonic dehydration; Regulation of K+metabolism, concepte and effect of Hypokalemia and Hyperkalemia;comprehensive:Physiology of Water and Electrolytes Metabolism, Causes and Pathogenesis of hypotonic dehydration, Hypertonic dehydration and Isotonic dehydration; Physiology of K+metabolism, Causes and Pathogenesis of Hypokalemia and Hyperkalemia; Physiology of Calcium , Phosphate metabolism and Magnesium; concept, Causes and Pathogenesi Effects of Hypocalcinemia, Hypercalcinemia ,Hypophosphatemia, Hyperphosphatemia, Hypomagnesium and Hypermagnesium.【CONTENT】.A. Physiology of Water and Electrolytes Metabolism(1)Water and Electrolytes Constituent(2)Intake and Excretion of Water(3)Exchange of Fluid between CompartmentsTwo semi-permeable membranes.Capillary membrane: colloid osmotic pressureCell membrane: crystal osmotic pressure.(4) Regulation of water and sodium balancea. Thirsty senseb. ADHc. Aldosterone(ALD)d. Natriuretic hormones2 Disorder of water and sodiumBasic pinciple of classification:(1) V olume of body fluid(2) Sodium concentration(3) Osmotic pressureB.Disorders of water and natrium metabolism:1. Hyponatremia : serum [Na+]<135mmol/L.1)Hypotonic dehydration (hyponatremia with volume loss) :A. Causes and Pathogenesisa)V olume loss from digestive tract, burned skin ,……b)V olume loss from kidneyB.Effects:Major loss of fluid: in ECFInadequate blood volume, skin dehydration--loss of skin turgor;……2) Hyponatremia with volume normal or gainA. Causes and Pathogenesis:B. Effects:Cell edema-brain edema:2. Hypernatremia: serum [Na+]>150mmol/L1) Hypertonic dehydration (hypernatremia with volume loss) : masterA) Causes and PathogenesisGreat loss of water or hypotonic fluida) From skin: fever, heavy sweat....b) From lung: hyperpneac) From digestive tract: diarrhea...d) From kiney: diabetes insipidus, osmotic diureticsWithout appropriate water replacement.B) Effects:a) Alteration of body fluid: Major loss of fluid in ICF, Dehydration of brain cellPlasma volume: recruitment from ICF- beneficial to maintain circulation.b): Heavy thirsty2). hypernatremia with volume excess: iatrogenic…. rare3) Idiopathic hypernatremia3. volume disturbance with normal plasma [Na+]1. Isotonic dehydration: dehydration with normal plasma [Na+]: masterA. Causes and PathogenesisExcessive fluid loss primarily from digestive tract, especially when kidney can maintain osmotic pressure normal (early stage)B. Effects:a) Alteration of body fluidMajor loss of fluid: in ECFb) Thirsty, Oliguria2. Edema (volume gain with normal plasma [Na+])See chapter 5C. Disorders of K+Metabolism1 Physiology of K+ metabolism(1). constituent of K+(2). Regulation of K+ metabolism1)Movement of K+ between intra- and extra-cellular fluid2)Excretion of K+ by kidney2. Hypokalemia : serum [K+] <3.5mmol/L: master(1) Causes and Pathogenesisa. Inadequate intakeb. Excessive loss:From digestive tract....From kidneyFrom skinc. Increased K+ shift into cells(2) Effectsa. On neuromuscular:Acute hypokalemia: Hyperpolarized blockingb. On heart:Excitibility↑Autorrhythmicity↑Conductivity↓Contractivity: acute --- ↑Chronic --- ↓c. On kidney: concentration ability of urine↓3 Hyperkalemia :serum [K+] >5.5mmol/L: master(1) Causes and Pathogenesisa. Decreased urinary excretion of K+b.Excessive K+ move out of cellsc.Inappropriate intake(2) Effectsa. On muscle:in mild stage: excitibility↑in severe stage: excitibility ↓: depolarized blocking b. on heart:excitibility: in mild stage:↑in severe stage:↓conductivity:↓autorhythmicity ↓Contractivity:↓D. Disorder of Calcium and Phosphate metabolism1. Physiology of Calcium and Phosphate metabolism(1) Constituent(2) Regulation of calcium and phosphate metabolism 2 Hypocalcinemia: serum Ca2+< 2.1mmol/L(1) Causes and Pathogenesis(2) Effects3 Hypercalcinemia: serum [Ca2+] >2.60mmol/L(1) Causes and Pathogenesis:(2)Effects4 Hypophosphatemia(1)Causes and Pathogenesis:(2) Effects5 Hyperphosphatemia(1) Causes and Pathogenesis:(2) EffectsE. Disorders of Magnesium1.Physiology of Mg2+ metabolism2. Hypomagnesium: serum [Mg2+] <0.8mmol/L(1) Causes and Pathogenesis(2) Effects3. Hypermagnesium: serum [Mg2+] >1.20mmol/L(1) Causes and Pathogenesis(2) EffectsChapter 4 Acid-Base Disturbances【AIM】master：Regulation of Acid-Base Balance; Laboratory parameters of Acid-Base Balance, Concept , Compensation and Effects of Metabolic Acidosis , Respiratory Acidosis , Metabolic Alkalosis and Respiratory Alkalosis on Body.comprehensive: Causes and Pathogenesis of Metabolic Acidosis , Respiratory Acidosis , Metabolic Alkalosis and Respiratory Alkalosis; Mixed Acid-Base Disorders, formula of compensatory response.【CONTENT】A. Regulation of Acid-Base Balance: master1. Chemical buffers2. Regulation of Lung3. Regulation of Kidney4. Role of cellsB. Laboratory parameters of Acid-Base Balance: master1. pH2. PaCO2: "respiratory parameter"3. Metabolic parameters: SB,AB, BE, CO2CP... Represent of HCO3- concentration4. Anion Gap (AG)C. Simple Acid-Base Disorders1. Metabolic Acidosis (M.Aci) : master(1) Concept : primary decrease of plasma [HCO3-](2) Causes and Pathogenesis1) M.Aci with normal AG2) M.Aci with AG↑(3)Compensation(4) Effects of Metabolic Acidosis on Body2. Respiratory Acidosis (R.Aci) : master(1) Concept : primary elevation of PaCO2(2)Causes and Pathogenesis: Ventilation↓(3)Compensation(4) Effects of Respiratory Acidosis on Body3. Metabolic Alkalosis (M.Alk) : master(1) Concept : primary increase of plasma [HCO3-](2) Causes and Pathogenesis"(3) Compensation(4) Effects of Metabolic Alkalosis on Body4. Respiratory Alkalosis (R.Alk) : master(1) Concept : primary decrease of plasma CO2(2) Cause and Pathogenesis: V entilation↑(3) Compensation(4) Effects of Respiratory Alkalosis on Body5. Mixed Acid-Base Disorders(1) Mixing patterns(2) Differentiation of Simple Acid-Base Disorders from Mixed Onesformula of compensatory responseChapter 5 Edema【AIM】master：Concept, Causes and Pathogenesis of edemacomprehensive: character of edema, classification and Causes and Pathogenesis of all kinds of edama.【CONTENT】A. Concept : excessive accumulation of interstitial fluidB. Causes and Pathogenesis1. Disequilibrium of fluid exchange between inside and outside body --Sodium and water retentionKidney : the primary organ for volume regulation(a) GFR↓(b) Redistribution of RBF(c) Increased reabsorption of Na+, H2O by proximal renal tubules:(d) Increased reabsorption of Na+, H2O by distal renal tubules:2. Disequilibrium of fluid exchange between intra- and extra-vessels(a)Capillaries blood pressure↑(b)Plasma colloid osmotic pressure↓(c)Capillary permeability↑(d)Lymphatic obstructionChapter six Hypoxia【AIM】master：Concept of hypoxia and parameters for blood oxygen; causes and Characteristics of blood oxygen and Pathogenesis of four kinds of hypoxia; Functional and Metaolic changes in hypoxiacomprehensive: Tolerance to hypoxia Oxygen, therapy and Oxygen toxicity 【CONTENT】A.Concept of hypoxia and parameters for blood oxygenB. . Etiology and Pathogenesis: master1. Hypotonic hypoxia(1) Causes(2)Characteristics of blood oxygen and Pathogenesis2. Hemic hypoxia(1) Causes(2) Characteristics of blood oxygen and Pathogenesis3. Circulatory hypoxia(1) Causes(2) Characteristics of blood oxygen and Pathogenesis4. Histogenous hypoxia(1)Causes(2)Characteristics of blood oxygen and PathogenesisC.Functional and Metaolic changes in hypoxia: master1. Respiratory system2. Circulatory system3. Hemic system4. CNS5. Cells and tissures alterationD. Tolerance to hypoxiaE. Oxygen therapy and Oxygen toxicityChapter seven Fever【AIM】master：Concept of Fever, Hyperthermia and physiological temperature increasing. Etiology and Pathogenesis of Fever, Concept of Endogenous pyrogen and Pyrogenic activator; the stages and characteristic of fever.comprehensive: Metabolic and functional alterations during fever, Biological significance of Fever and pathophysiologic basis of fever therapy.【CONTENT】A. Concept:1. Fever2)Hyperthermia3)physiological temperature increasingB. Etiology and Pathogenesis of Fever: master1. Pyrogenic activator:2. Endogenous pyrogen (EP, Pyrogenic cytokines)(1) EPs: IL-1, IL-6, TNF, Interferon (INF)(2). ways of EP signal the CNS(3)Operating mechanisms of EPa. PGE2b.CRH，cAMP，Ca2+，5-HT……3.Endogenous cryogens: Febrile ceilingC. Stages of Fever1 Fervescence period:2 Persistant febrile period3 Defervescence periodD. Metabolic and functional alterations during fever1 CNS2 Immune system3 Digestine system4 Cardiovascular system5 Metabolic changesE. Biological significance of Fever (risk-benefit considerations)F. pathophysiologic basis of fever therapyChapter eight Stress【AIM】master：Concept of stress, Stressor; Stress responses: Locus ceruleus-norepinephrine/sympathetic /adrenal medulla axis, Hypothalamus-Pituitary-Adrenal Cortex System, Acute Phase responses and Acute Phase Protein, Heat Shock Protein, GAS (General Adaptation Syndrome), Stress ulcer,prehensive: Function and Metabolism responses, Essential Hypertension, Myocardial ischemia and arrhythmias, stress related mental-psychogenic disorders 【CONTENT】A. Concept of stress, Stressor:B. Stress responses1 Nervous and Hormones responses during Stress(1). Locus ceruleus-norepinephrine/sympathetic /adrenal medulla axis:(2). Hypothalamus-Pituitary-Adrenal Cortex System:(3). Other hormones2 Cellular & Humoral responses:(1). Acute Phase responses and Acute Phase Protein (AP)(2). Heat Shock Protein (HSP or Stress Protein)3 Function and Metabolism responses(1). Metabolism(2). C.N.S(3). Cardiovascular system(4). Digestive system(5). Immune system(6). Blood system(7). Urinary and Reproductive systemC. Stress Related Disease1 GAS (General Adaptation Syndrome) :2 Stress ulcer:Concept and Pathogenesis of stress ulcer3 Other stress related diseases(1). Essential Hypertension(EP)(2). Myocardial ischemia and arrhythmias(3)stress related mental-psychogenic disordersChapter 9 Shock【AIM】master：Concept of shock; Pathogenesis of shock; cause, characteristic, pathogenesis and compensation of stages of shock. Concept and pathogenesis of Pulmonary dysfunction, Hepatic dysfunction, Renal dysfunction, Cardiac dysfunction, MODS (multiple organs dysfunction syndrome), SIRS (systemic inflammatory response syndrome)comprehensive:Etiology and classification of shock, Disturbances of cell metabolism and function Gastrointestinal dysfunction during shock.【CONTENT】A. Concept: : masterAcute circulatory failure lead tissue perfusion reduced greatly, severe dysfunction of vital organs, cell damage and eventually death if without prompt rescue.B. Etiology and classification of shock(A) Classification on etiology(B) Classification on initiation of shockC. Pathogenesis: master1. V asoconstriction stage --- The early phase of shock , stage of ischemic anoxia(1) V asoconstriction mechanism(2) Compensative significance in vasoconstriction stage Ⅰ(3) Manifestation:2. Stagnant anoxia stage --- The developed phase of shock, -reversible decompensatory stage(1) mechanism of disturbances of microcirculation(2) major effects of the disturbances3. V asofailure stage --- refractory phase of shockDICOrgans failureD. Effects of shock1.Disturbances of cell metabolism and function2.Pulmonary dysfunction: master3.Hepatic dysfunction: master4.Renal dysfunction: master5.Gastrointestinal dysfunction6.Cardiac dysfunction: master7.MODS (multiple organs dysfunction syndrome)SIRS (systemic inflammatory response syndrome)Concept and pathogenesisChapter 10 Disseminated Intravascular Coagulation DIC【AIM】master：Concept, Causes and pathogenesis of Disseminated Intravascular Coagulation; Predisposing and precipitating factors; Consequences of DICcomprehensive: Types and stages of DIC, Pathophysiologic basis of DIC diagnosis and treatment【CONTENT】A Concept: masterB Causes and pathogenesis: master1.Abnormal activation of clotting cascade2. Fibrinolytic defectC Predisposing and precipitating factors: master1. Impairment of mononuclear phagocyte system2. Hypercoagulable state3. Disorders of microcirculationb.Severe hepatic disordersc.Defects in inhibitors of coagulationD Types and stages of DIC1. Stagesa) hypercoagulable stageb) hypocoagulable stagec) fibrinolytic stage2. typesbased on attacking velocitybased on compensationE Consequences of DIC: master1. Bleeding2.Shockans, tissues damage4. microangiopathic hemolytic anemiaF Pathophysiologic basis of DIC diagnosis and treatmentChapter 11 pathophysiological basis of oncology【AIM】master：Proto-oncogene and oncogene; Transformation of Proto-oncogene to oncogene; Concept and Tumorigenic mechanism of Tumor suppressor genes; DNA repair pathway genes;comprehensive:environmental basis of cancer Environmental carcinogen; Process of invasion and metastasis; Mechanism of metastases ;Multistep tumorigenesis.【CONTENT】ⅠPart environmental basis of cancerEnvironmental carcinogenA、Chemical carcinogen(A) polycyclic aromatic hydrocarbons (PAHs)benzo(a)pyrene(B) N-nitroso-compounds (NOC)(C) biotoxins aflatoxinB、Physical carcinogen(A) ionizing radiation(B) ultraviolet radiationC、Tumor viruses(A) DNA viruses1. Hepatitis B2. Papovavirus(1) Human papilloma virus (HPV)(2) Epstein-Barr virus (EBV)(B) RNA virusesHepatitis C virus (HCV)(C) Retroviruses1. human T cell lymphotropic virus -Ⅰ, -Ⅱ2. human immunodeficiency virus (HIV-1)Ⅱ: masterPart Genetic basis of cancerA、Proto-oncogene and oncogene(A) Proto-oncogenesRegulator of cell growth, proliferation, differentiation, …(B) Transformation of Proto-oncogene to oncogeneMutation causing a gain of function – dominant mutation1. Point mutation2. Gene amplification3. Chromosome translocation4. Deletion5. Virus oncogene integration (V-onc)B、Tumor suppressor genes(A) Concept of tumor suppressor genesA class of gene inactivated by germline or somatic mutation causing the loss of function (recessive mutation) in cancer.(B) Tumorigenic mechanismTwo hit hypothesisThe second mutation：loss of heterozygosity (LOH)(C) Identified, important tumor suppressor gene1. Rb gene ( retinoblastome gene)2. p53 geneC、DNA repair pathway genes(A) DNA damage(B) Repair of DNA damage (mismatch repair)(C) Repair gene defects and cancerⅢPart Invasion and metastasesA、Process of invasion and metastasisExtensive vascularization (angiogenesis)Local invasion of the host stroma,Embolization of tumor cellsArrest in capillary beds of distant organs by adhering.Extravasation,B、Mechanism of metastases1. Changes of cell adhesion molecules2. Extracellular matrix degradative enzymes3.Motility factors, tumor angiogenesis factors……4.Metastasis genes5.Metastasis suppressor genes6.Metastatic heterogeneityⅣPart Multistep tumorigenesisChapter 12 Pathophysiology of cardiovascular system【AIM】master：Concept of heart failure; Pathogenesis of heart failure: Disorders of myocardiaccontraction and Disorders of myocardial dilation and compliance; Adaptation and compensation for heart failure; Effects of heart failurecomprehensive: Etiology of heart failure;【CONTENT】A.Heart Failure(A) Concept: master(B) Etiology1. Primary disorders of myocardium2. Overload of myocardium(C) Pathogenesis: master1.Disorders of myocardiac contraction(1) Damage of myocardium(2) Disturbances of myocardial energy metabolism(3) Abnormalities in excitation-contraction coupling – disorders of Ca2+ transportation 2. Disorders of myocardial dilation and compliance(1) Disorder of myocardial dilation(2) Decreased ventricular compliance(D) Adaptation and compensation for heart failure : master1.mobilize pump reserve2.myocardial remodeling3.activation of neuro-hormoral factors4.adaptation of cell, tissue to hypoperfusion(E)Effects of heart failure: master1. Effects of decreased cardiac output – forward failure2. Effects of venous congestion – backward failureChapter 12 Pathophysiology of respiratory systemRespiratory Failure【AIM】master：concept and classification of respiratory; Etiology and Pathogenesis of respiratory: concept and pathogenesis of V entilation disorders, Diffusion disorders ,Mismatching of V/Q and True shunt. concept and pathogenesis of Acute respiratory failure in acute respiratory distress syndrome (ARDS); Consequences of respiratory failure :Alteration of circulatory system-Cor pulmonale ,CNS alteration- Pulmonary encephalopathycomprehensive: Consequences of respiratory failure【CONTENT】A.Concept: : master Pa O2↓ < 60 mmHgType : Pa OⅠ2↓< 60 mmHgⅡ2↓, PaCO2↑> 50 mmHg (6.67 kPa)Type : Pa OB. Etiology and Pathogenesis: master1 V entilation disorders(1) Restrictive hypoventilation(2) Obstructive hypoventilation(3) Alteration of blood gases2. Diffusion disorders(1) Area of diffusion membrane↓(2) Thickening of diffusion membrane(3) Alteration of blood gases3 Mismatching of V/Q(1) V/Q↓: functional shunt (venous admixture)(2) V/Q↑: dead space-like ventilation(3) Alteration of blood gases4 True shunt ↑C. Acute respiratory failure in acute respiratory distress syndrome (ARDS)1.pathogenesis of ARDS2.pathogenesis of ARDS leading acute respiratory failureD. Consequences of respiratory failure: master1 Acid- Base Disturbances(1) Respiratory AcidosisHyperkalemia, Hypochloremia(2) Metabolic Acidosis or Mixed Acidosis(3) Respiratory Alkalosis2 Alteration of Respiratory System3 Alteration of circulatory systemCor pulmonale4 CNS alterationPulmonary encephalopathy5 Alteration of kidney and digestive systemChapter 13 Hepatic Pathophysiology【AIM】master：Concept of Hepatic Encephalopathy; Pathogenesis of Hepatic Encephalopathy:Ammonia intoxication ,False neurotransmitters, Amino acid imbalance, GABA ↑. comprehensive:Etiology Disorders of hepatic cell function; Disorders of Kupffer cell function; Jaundice with predominantly unconjugated hyperbilirubinemia; Jaundice with predominantly conjugated hyperbilirubinemia Effects of hyperbilirubinemia; Precipitating factors and Principles of therapy of Hepatic Encephalopathy【CONTENT】A. General introduction to disturbances of hepatic functions1. Etiology2. Disorders of hepatic cell function3. Disorders of Kupffer cell functionB. Jaundice(A) normal metabolism of bilirubin(B) Jaundice with predominantly unconjugated hyperbilirubinemia1.overproduction of bilirubin: hemolysis jaundice, etc2.impaired hepatic uptake, conjugation of bilirubin : neonatal physiological jaundice,etc.(C) Jaundice with predominantly conjugated hyperbilirubinemia1.Hepatocellular jaundice2.Intrahepatic cholestatic jaundice3.Obstructive jaundice, etc(D) Effects of hyperbilirubinemia1.Effects of cholestasis2.KernicterusC Hepatic Encephalopathy (HE) : master(A) Concept: neuropsychiatric syndrome secondary to severe hepatic disease(B) Pathogenesis1. Ammonia intoxication(1) Mechanism of blood NH3↑(2) Toxic roles of NH32. False neurotransmitters(1) production of False neurotransmitters(2) False neurotransmitters in hepatic coma3. Amino acid imbalance(1) BCAA/AAA ↓: pathogenesis and effects in HE(2) 5-HT ↑: pathogenesis and effects in HE4. GABA ↑: pathogenesis and effects in HE(C) Precipitating factors(D) Principles of therapyChapter 14 Renal Pathophysiology【AIM】master：Concept of Acute Renal Failure (ARF); Etiology , classification and Pathogenesis of ARF;the mechanism of Oliguric; concept of Azotemia; Concept and Etiology and Pathogenesis of CRF; Concept of Uremiacomprehensive:Primary etiology of Renal failure; Primary functional impairments of kidney; Development courses of CRF; Pathogenesis of Uremia ;Functional and metabolic alterations in uremia.【CONTENT】A. General Introduction1.Primary etiology2.Primary functional impairments of kidney(1) Glomerulus impairment(2) Renal tubular impairment(3) Disturbances of bioactive substances produced by kidneyB. Acute Renal Failure: master(A) Concept of ARF(B) Etiology and classification(C) Pathogenesis1.intrarenal hemodynamic disturbances - GFR↓2.renal tubular impairment(D) Effects of ARF1. Oliguric type(1)Oliguric phase: Alteration of urineAzotemiaWater, Electrolytes and acid-base disordersendocrinous Disturbances(2) Diuresis phase(3) Phase of functional recovery2. non-oliguric type: characteristicsC Chronic Renal Failure: master(A) Concept and Etiology(B) Development courses of CRF(C) Pathogenesis of CRF: Intact nephron hypothesis1.glomerulosclerosis2.tubulointerstitial injury(D) Functional and metabolic alterations in CRF1. Water, Electrolytes and acid-base disorders2. Azotemia3.renal hypertension4.impairment of hemic system5.renal osteodystrophyE Uremia(A) Concept(B) Pathogenesis1.renal Toxins2.PTH(C) Functional and metabolic alterations in uremia四、Textbook: （教材）陈主初主编《病理生理学》人民卫生出版社，北京，2001.8王建枝主编《Pathophysiology》In press人民卫生出版社，北京，2005.3五、The recommended books include：（参考资料）Kaufman.C E & Mckee.PA 《Essentials of Pathophysiology》中国协和医科大学出版社，北京，2002.1 (英文影印版)王迪浔，金惠铭主编，《人体病理生理学》第二版，人民卫生出版社，北京，2002.8成绩评定：本课程考试为理论考核，满分100分。

引言：概述：《病理学》教学大纲（二）是病理学课程的进阶部分，侧重于探索更深入的疾病机制和相关的实验室技术。

通过学习该课程，学生将进一步理解疾病的病因学、发病机制以及不同病理类型的诊断和治疗方法。

正文：一、病理学原理与方法1.细胞和组织学细胞的基本结构和功能组织学的基本概念和分类组织学染色技术及其应用2.病理学与免疫学免疫学的基本原理和免疫系统的功能免疫病理学的基本概念和分类免疫病理学在疾病诊断和治疗中的应用3.分子病理学分子生物学基础知识分子病理学技术和应用分子病理学在疾病预后评估中的作用4.病理生理学病理生理学的基本概念和原理病理生理学在常见疾病中的应用病理生理学与药物治疗的关系5.实验室病理学技术组织切片制备和染色技术免疫组化和原位杂交技术分子诊断技术在实验室病理学中的应用二、常见疾病的病理学特征1.感染性疾病细菌感染性疾病的病理学特征病毒感染性疾病的病理学特征真菌和寄生虫感染性疾病的病理学特征2.免疫性疾病自身免疫性疾病的病理学特征过敏性疾病的病理学特征移植排斥反应的病理学特征3.代谢疾病代谢紊乱引起的病理学变化遗传代谢疾病的病理学特征肿瘤相关代谢疾病的病理学特征4.其他系统性疾病心血管系统疾病的病理学特征呼吸系统疾病的病理学特征神经系统疾病的病理学特征5.肿瘤病理学肿瘤发生、发展和转移的病理学特征常见肿瘤类型的病理学特征肿瘤病理学在肿瘤诊断和治疗中的应用总结：《病理学》教学大纲（二）涵盖了病理学的原理、方法和常见疾病的病理学特征。

通过深入学习该课程，学生将对疾病的发生和发展机制有更全面的理解，并能够运用相关实验室技术进行疾病的诊断和治疗。

该课程的学习将为学生的医学职业发展奠定坚实的基础。

《病理生理学》课程教学大纲课程名称：病理生理课程类型:选修课总学时： 36 讲课学时：36 学分：2学分适用对象: 制药工程专业先修课程：解剖生理学、药理学一. 课程的性质和任务《病理生理学》是医学基础理论学科之一。

是研究疾病的机制并结合机体机能代谢的变化。

阐明疾病发生、发展的基本规律，揭示疾病的本质，为疾病的防治提供理论根据。

病理生理学的基本内容分总论和各论两部分。

总论主要讲述疾病中带有共性的规律及基本病理过程，各论主要讲述机体各系统疾病发生规律以至每一种疾病的特殊规律。

通过教学使学生正确理解机体与环境，内因和外因、局部与整体、机能与形态、损伤与抗损伤等辩证关系，培养学生观察问题、分析问题和解决问题的能力，为以后临床实践和科学研究打下牢固基础。

二、教学基本要求教学要求分三个层次：掌握、熟悉、了解。

考核内容对应三个相应的层次，要求掌握的内容占80％，熟悉的内容占15％，了解的内容占5％。

四、课程的重点和难点：绪论重点是生物化学对人类的深刻影响。

第一章绪论重点：①健康、亚健康与疾病的概念②脑死亡，判断脑死亡的标准及其意义。

难点：①病因及条件在疾病发生中的作用②疾病发生发展的一般规律。

第二章水、电解质代谢重点：①体液容量和渗透压平衡的调节②正常钾代谢及钾代谢紊乱，低钾和高钾血症难点：①低渗性脱水、高渗性脱水、等渗性脱水②病因和机体的功能代谢变化第三章水肿重点：①水肿的概念、分类、病因和机制。

难点：①水肿发病机制。

第四章酸碱平衡重点：酸碱平衡及酸碱平衡紊乱的概念和机体对酸碱平衡的调节方式与特点。

难点：①四种单纯性酸碱平衡紊乱的原因、特征和机制。

第五章缺氧重点：缺氧的原因与机制及机体代谢变化。

难点：缺氧机能代谢变化。

第六章发热重点：发热的原因及机制。

难点：发热反应中机体的机能、代谢变化。

第七章应激重点：应激相关疾病的病理生理基础难点：应激相关疾病的病理生理基础。

第八章疼痛重点：①掌握疼痛的概念①掌握疼痛的发生机制难点：疼痛的发生机制。

《病理生理学》课程教学大纲课程名称：病理生理学英文名称：Pathophysiology课程类型: 必修专业基础课(影像专业为选修)总学时：72（临床医学76）讲课学时：48 实验学时：24（临床医学28）适用对象:临床医学、心电与超声、卫生事业管理、麻醉学、急救医学专业方向、影像学、药学等专业使用课程简介：病理生理学是一门研究疾病发生发展规律和机制的科学。

在医学教学中，它不仅是一门重要的医学基础理论课，而且也是一门沟通基础医学和临床医学的桥梁学科，被国家教委列为医学教学中的主干课程之一。

通过对病理生理学的学习，要求学生能掌握其基本理论、基本知识和基本技能，提高学生综合分析问题和解决问题的能力，为疾病的诊断和防治提供必要的理论基础。

一、课程性质、目的和任务病理生理学（pathophysiology）是一门研究疾病发生发展规律和机制的科学。

对这些规律和机制的深入认识不但有助于学生深入认识疾病，而且，由于近年来对疾病发生机制研究的飞速进展，病理生理学的内容更成为医学相关专业的学生和从业者跟上这种进展步伐的重要基础。

病理生理学又是一门与多学科密切相关的桥梁性学科。

它不仅与解剖学、组织学、遗传学、免疫学、生理学、生物化学、病理学等密切相关，而且与临床各科亦密切相关。

病理生理学是连接基础医学与临床医学的一门过渡性学科。

学好病理生理学将显著拓宽医学生的视野，增强他们的后劲。

病理生理学的任务是研究疾病发生的原因和条件，研究疾病全过程患病机体的机能、代谢变化及其机制以揭示疾病发生、发展和转归的规律，为疾病的防治提供理论依据。

二、教学基本要求本大纲对该课程的理论教学按照要求程度的不同，分为“掌握”、“熟悉”和“了解”三个层次。

掌握：要求对教材内容能够深入透彻地理解，牢固记忆，并能灵活运用。

熟悉：对教材内容以清楚地理解，并记住其中主要内容。

了解（或自学）：对教材内容一般理解。

三、教学内容及要求第一章绪论【熟悉】病理生理学的任务和研究方法。

《病理生理学》课程教学大纲（护理专业三年制专科适用，54学时）一、课程性质病理生理学是医学基础理论学科之一，是研究疾病发生的原因、条件、发展规律、发病机制以及疾病过程中机能和代谢变化的专业基础课；是医学专业的基础医学课程，是基础医学与临床医学之间的桥梁。

二、教学任务病理生理学作为本科的主干课程之一，其任务是通过教学使学生掌握常见病理过程和疾病的病理生理知识，为学习临床医学课程、认识及防治疾病奠定理论基础。

三、教学基本要求通过本课程的学习，要求学生能够掌握病理生理学的基本理论、基本知识和基本方法，为后续的临床课程打下必要的基础；也是为毕业后在医疗、卫生实践中，不断提高业务能力提供必要的基础。

四、教学时间安排五、本门课程与其他课程关系病理生理学是临床医学专业的基础医学课程，是基础医学与临床医学之间的桥梁。

就学科本身而言，病理生理学的范畴非常广泛。

研究许多疾病乃至所有疾病共有的规律，是病理生理学总论的任务；研究各系统疾病的一般规律乃至每一种疾病的特殊规律，是病理生理学各论的任务。

为学习临床医学课程、认识及防治疾病奠定理论基础。

六、主要教学方法、要求及考核方式学生应当通过听课、自学、讲授式+启发式+提问式+多媒体等教学方法，掌握上述内容的基本理论；在实验课中应学会和应用实验方法，培养和训练基本技能，分析实验结果，得出实验结论，培养实践能力和创新精神，努力提高学生的综合素质。

总评成绩=平时成绩+理论成绩平时成绩占30%，理论成绩占70%。

七、教学主要内容纲要绪论（一）基本目的与要求1.要求掌握病理生理学的任务，熟悉本学科的性质、内容和研究方法，2.了解其在医学教育中的地位、作用和发展简史。

3.通过学科特点及教学方法的简介，为学生主动地学习病理生理学打下基础。

（二）教学的重点和难点重点：病理生理学的学科性质及其主要任务，基本病理过程的概念，循证医学的概念及其基本原则，人类基因组计划对病理生理学的影响。

难点：研究方法中疾病模型的复制不好理解，结合我室克山病病因的动物实验研究讲授，以突破难点。

病理生理学教学大纲（临床医学专业）一、课程名称：病理生理学（Pathophysiology）二、教学对象本大纲适用于临床医学专业五年制本科学生。

三、学分与学时：4学分：总学时为70学时，其中理论课45学时，实验课25学时。

四、课程模块及课程属性：本课程为专业基础课程模块必修考试课程。

五、课程性质、任务和要求病理生理学是从机能代谢的角度研究疾病发生发展规律和机制的科学。

在医学教学中，它是一门连接基础医学与临床医学的桥梁学科。

它的任务是以辩证唯物主义为指导思想阐明疾病发生发展的本质，为疾病的防治提供理论依据和实验依据。

六、教学重点：本课程的教学重点是各章节内容的基本概念、发生机制、机能代谢变化。

七、主要先修课程：生理学、生物化学、遗传学、人体解剖学、病理解剖学、药理学、免疫学、生物物理学、微生物学、寄生虫学。

八、教学目的要求和主要内容：病理生理学的研究对象是疾病，作为研究疾病的基础课，它需要引导学生在了解正常人体知识的基础上过渡到学习基本病理过程及重要器官功能衰竭的有关知识上来。

从而培养具有一定专业知识、基本实验操作技能、分析问题解决问题能力、创新思维的本科医学生。

第一章绪论、疾病概论（3学时）【目的要求】1.掌握病理生理学的学科性质与教学任务;2.熟悉疾病发生的原因和条件，疾病(发生)发展的基本机制和一般规律;3.了解新的死亡（脑死亡）概念。

【主要内容】一、绪论：1.病理生理学的学科性质、教学任务。

2.病理生理学的学习内容及主要学习和研究方法。

3.病理生理学的发展简史。

二、疾病概论：1．疾病概念。

2．疾病发生的原因和条件，疾病发生发展的基本机制、一般规律和转归。

3．脑死亡的诊断标准和意义。

第二章水、电解质代谢紊乱（3学时）【目的要求】1、掌握低容量性低钠血症、高容量性低钠血症、水肿、水中毒的基本概念、发生原因、发生机制、机体机能代谢变化及临床特征。

2、熟悉钾代谢障碍的分类、发生原因、发生机制、机体机能代谢变化及临床特征。

《病理生理学》Ⅲ教学大纲一、课程基本信息课程编码：501008030课程名称：病理生理学III课程英文名称：Pathophysiology III课程性质：专业基础课授课对象：法医，医学技术等学时：48学时学分：3学分二、教学目的及要求病理生理学是医学教育的一门主干学科，是医务人员必须掌握的一门基础医学知识。

病理生理学主要探讨疾病发生、发展的规律和机制，对这些规律和机制的深入认识不但有助于学生深入认识疾病，而且，由于近年来对疾病发生机制研究的飞速进展，病理生理学的内容更成为医学相关专业的学生和从业者跟上这种进展步伐的重要基础。

学好病理生理学将显著拓宽医学生的视野，增强他们的后劲。

病理生理学又是一门与多学科密切相关的桥梁性学科。

它不仅与解剖学、组织学、遗传学、免疫学、生理学、生物化学、病理学等密切相关，而且与临床各科亦密切相关。

病理生理学是连接基础医学与临床医学的一门过渡性学科。

三、教学内容第一章病理生理学发展简史掌握：病理生理学现代概念；病理生理学与病理解剖学、生理学异同。

熟悉：病理生理学建立的标志（实验生理学、体液病理学和细胞病理学）了解：病理生理学创建过程。

【授课内容】一、病理生理学概念建立二、病理生理学的成长熟过程三、病理生理学的展望第二章疾病相关的基本概念掌握：健康（WHO定义）、疾病（基于稳态紊乱定义）、基本病理过程、病因（基本病因）、致病机制（基本机制）、条件、诱因、死亡和脑死亡（全脑死亡）的概念。

熟悉：亚健康、亚临床疾病、综合征、危险因素、易感性、遗传易感性、死因的概念。

了解：健康维度、健康促进、死亡诱因、死亡辅因、猝死、植物状态、昏迷、安乐死、假死的概念。

【授课内容】一、健康与疾病二、疾病（一）病因（二）疾病的发病机制（三）疾病的异常生理表现三、健康与疾病的转化（一）亚健康（二）亚临床疾病四、探讨健康与疾病概念的意义五、生与生命六、死（一）传统死亡（二）脑死亡（三）信息-理论死亡（四）死因（五）与死亡相关的状态第三章疾病发病机制概论掌握：①复杂疾病概念和表现；传统与现代生物研究模式对疾病发病机制不同的观点；②各组学概念、系统生物学概念、特点，及其在复杂疾病发病机制中的作用；③良性循环、恶性循环概念。