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case discusion-2 病理生理学双语课件
MODS 病例讨论
(13日)主诉：左上肢断裂，全身多处刀伤，伴流 血疼痛7小时。
现病史：入院前晚全身多处刀伤，左上肢断裂， 大量流血后出现昏迷，在当地医院作伤口处理与 输血、输液治疗。
入院查体：T：37℃，R：22次/分，P：130次/ 分，BP：75/50mmHg。一般情况：神清，烦躁， 脸色苍白，大汗淋漓，左手无感觉，挠动脉搏动 消失。
D-二聚体（+），
肾功：Cr：283umol/L， 查体： T： 37.7 ℃，HR：145次/分，BP：
96/48mmHg，SPO2:98%.
处理：行断臂再植术。
病情发展
（15日）：患者持续镇静，双侧睑结膜充 血水肿，头面部及胸廓肿胀，胸部饱满，皮 下软组织水肿积液。胸腔少量引流液 （100ml/24小时），液面未见明显波动， 胸部抠诊音浊，心音微弱。
实验检查：WBC:12.0 ×109/L, RBC:2.91 ×1012/L, HGB:110g/L, PT:28s,
(13日)主诉：左上肢断裂，全身多处刀伤，伴流 血疼痛7小时。
现病史：入院前晚全身多处刀伤，左上肢断裂， 大量流血后出现昏迷，在当地医院作伤口处理与 输血、输液治疗。
入院查体：T：37℃，R：22次/分，P：130次/ 分，BP：75/50mmHg。一般情况：神清，烦躁， 脸色苍白，大汗淋漓，左手无感觉，挠动脉搏动 消失。
D-二聚体（+），
肾功：Cr：283umol/L， 查体： T： 37.7 ℃，HR：145次/分，BP：
96/48mmHg，SPO2:98%.
处理：行断臂再植术。
病情发展
（15日）：患者持续镇静，双侧睑结膜充 血水肿，头面部及胸廓肿胀，胸部饱满，皮 下软组织水肿积液。胸腔少量引流液 （100ml/24小时），液面未见明显波动， 胸部抠诊音浊，心音微弱。
实验检查：WBC:12.0 ×109/L, RBC:2.91 ×1012/L, HGB:110g/L, PT:28s,
《病理生理学》PPT课件
病理生理学
第一章 绪 论
说出病理生理学的任务 说出病理生理学的内容 简述病理生理学的性质及研究方法 简述病理生理学的发展简史
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。
以患病机体为对象 以功能与代谢变化为重点 研究疾病发生、发展和转
归的规律与机制
疾病(disease)
机体在一定病因作用下，自稳调 节紊乱导致的异常生命活动过程.
自稳调节的紊乱 损害和抗损害反应
机能、代谢和形态 结构的异常变化
临
症状主观上的异常感觉
床
体征客观表现
表
现
行为异常
第2节 疾病发生的原因和条件
病因（Etiology）
健康机体
不利条件 （诱因）
（+）
病因
患病机体
（－） 有利条件
(三) 脑死亡的意义
◆ 有利于判定死亡时间 ◆ 确定终止复苏抢救的界线 ◆ 为器官移植创造条件
6. 先天性因素(congenital factors)
能够损害胎儿生长发育的有害因素
7. 免疫性因素(immunological factors)
过敏反应
强烈的反应，致使组织细 胞损伤和生理功能障碍。
自身免疫性疾病
自身抗原发生反应引起自 身组织的损害造成的疾病。
免疫缺陷病
因体液免疫或细胞免疫缺 陷所引起的疾病。
病因 －引起疾病，赋予其特异性的因素
1.生物性因素
病因的类型
• 病原微生物和寄生虫 特点: 有一定的入侵门户和定位
链球菌
2. 物理性因素(physical agents)
机械力 温度 气压 电流 电离辐射
外伤、骨折 冻伤、烧伤、中暑 潜水员病 电击伤 放射伤
第一章 绪 论
说出病理生理学的任务 说出病理生理学的内容 简述病理生理学的性质及研究方法 简述病理生理学的发展简史
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。
以患病机体为对象 以功能与代谢变化为重点 研究疾病发生、发展和转
归的规律与机制
疾病(disease)
机体在一定病因作用下，自稳调 节紊乱导致的异常生命活动过程.
自稳调节的紊乱 损害和抗损害反应
机能、代谢和形态 结构的异常变化
临
症状主观上的异常感觉
床
体征客观表现
表
现
行为异常
第2节 疾病发生的原因和条件
病因（Etiology）
健康机体
不利条件 （诱因）
（+）
病因
患病机体
（－） 有利条件
(三) 脑死亡的意义
◆ 有利于判定死亡时间 ◆ 确定终止复苏抢救的界线 ◆ 为器官移植创造条件
6. 先天性因素(congenital factors)
能够损害胎儿生长发育的有害因素
7. 免疫性因素(immunological factors)
过敏反应
强烈的反应，致使组织细 胞损伤和生理功能障碍。
自身免疫性疾病
自身抗原发生反应引起自 身组织的损害造成的疾病。
免疫缺陷病
因体液免疫或细胞免疫缺 陷所引起的疾病。
病因 －引起疾病，赋予其特异性的因素
1.生物性因素
病因的类型
• 病原微生物和寄生虫 特点: 有一定的入侵门户和定位
链球菌
2. 物理性因素(physical agents)
机械力 温度 气压 电流 电离辐射
外伤、骨折 冻伤、烧伤、中暑 潜水员病 电击伤 放射伤
病理生理英文课件
PVN CRH↑
LC-NE
limbic system
Peripheral effector Physical stress response
Emotion stress response
pituitary ACTH↑
Cortex of adrenal gland
GC↑
23
Stress
(2) Basic effects of stress
Stressor
Internal factors
Homeostasis, disease, cancer.
Psychological, sociological factors
Work pressure, life rhythm, interpersonal relation
6
Stress
7
8
human
burn operation infection hypoxia Strong light noise necrosis
Definite intensity stimulate
Specific reactions
fester acidosis
non-specific reaction
Stress
anxiety dread blood reditribution HR ↑
peri-resistance↑ prolonged
blood redistribition
key organs blood supply
Heart afterload↑ hypertension unfavorable results
21
3）Respiratory system StressRR faster & deep O2 carrying ↑ tissue O2 supply↑ Respiratory alkalosis tissue lack blood & O2 unfavorable results
病理生理学课件：英文课件汇总
of brain e) Breath stop over 15 min under
resuscitation f) Brain ciVegetative state: death of cerebral cortex with alive brain stem.
Health: a normal state in soma,
psyche and social well-being
Chapter 2
二.Etiology
1. Etiological factors: the direct cause
1) Biological factor 2) Physiological factor 3) Chemical factor
Chapter 2
3. Precipitating factor
The factor that promote ,intensify the
disease attack.
Chapter 2
三.Development of Disease 1. General rules
1) Damage and Antidamage Responses The fight between etiology and body
60% (±)of body weight Intracellular fluid : 40% Interstitial fluid : 15% Transcellular fluid : 2% Plasma : 5%
defence 2) Interchange of Cause-Effect
The evolution of disease
Chapter 2
2. Basic Mechanisms
resuscitation f) Brain ciVegetative state: death of cerebral cortex with alive brain stem.
Health: a normal state in soma,
psyche and social well-being
Chapter 2
二.Etiology
1. Etiological factors: the direct cause
1) Biological factor 2) Physiological factor 3) Chemical factor
Chapter 2
3. Precipitating factor
The factor that promote ,intensify the
disease attack.
Chapter 2
三.Development of Disease 1. General rules
1) Damage and Antidamage Responses The fight between etiology and body
60% (±)of body weight Intracellular fluid : 40% Interstitial fluid : 15% Transcellular fluid : 2% Plasma : 5%
defence 2) Interchange of Cause-Effect
The evolution of disease
Chapter 2
2. Basic Mechanisms
【英文课件-病理生理学】_病理学Pathology-上海交通大学医学院学习
l Increase in the size of cells resulting in
increase in the size of the organ l No new cells, just bigger cells l Occurs in cells that cannot divide l Physiologic – weight lifter l Pathologic - cardiac enlargement –
活组织检查(biopsy) 对活体组织采用局部切除、钳取、针吸、
搔刮等方法，进行取材检查
意义：在活体情况下对患者作出诊断；术中诊断，协助选择
术式和手术范围；随诊观察病情，判断疗效；组织化学和细胞化
学等方法进一步诊断
A biopsy is a medical test commonly performed by a surgeon or an interventional radiologist involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease.
1.特点：实质细胞、组织或器官的体积缩小，细胞数 量的减少。
2.类型：（1） 生理性萎缩:老年子宫的萎缩,青春期 的胸腺萎缩
（2）病理性萎缩：
①营养不良性萎缩（inadequate nutrition） 脑缺血→脑萎缩
②压迫性萎缩（pressure） 肾盂积水 → 肾萎缩
③废用性萎缩（decreased workload) 长期卧床 → 肌肉萎缩
【英文课件-病理生理学】_信号转导异常与疾病Signal Transduction
EGF signaling pathway
Cytokine Receptors
Each cytokine/hematopoietic receptor is a composite of structurally distinct protein domains. Members of this receptor family contain one, two, or even three polypeptides. The transmembrane domain consists of a single alpha helix of about 20 amino acids. Ligand binding occurs at a domain near the transmembrane domain
Adenylate cyclase mediated pathway Phospholipase mediated pathway Small G-protein-mediated pathway
Ligands Receptors G-proteins Enzymes Second messengers Kinases Enzymes or functional proteins Biological effects
Gq/11
3rd messenger
Non-G-protein-mediated pathway
Receptor tyrosine kinase mediated pathway Receptor serine/threonine kinase mediated pathway Intracellular (nuclear) receptor mediated pathway
Cytokine Receptors
Each cytokine/hematopoietic receptor is a composite of structurally distinct protein domains. Members of this receptor family contain one, two, or even three polypeptides. The transmembrane domain consists of a single alpha helix of about 20 amino acids. Ligand binding occurs at a domain near the transmembrane domain
Adenylate cyclase mediated pathway Phospholipase mediated pathway Small G-protein-mediated pathway
Ligands Receptors G-proteins Enzymes Second messengers Kinases Enzymes or functional proteins Biological effects
Gq/11
3rd messenger
Non-G-protein-mediated pathway
Receptor tyrosine kinase mediated pathway Receptor serine/threonine kinase mediated pathway Intracellular (nuclear) receptor mediated pathway
病理生理学Pathophysiology
皮肤粘膜：
发绀
？
2019/10/23
病理生理学 Pathophysiology
2019/10/23
病理生理学 Pathophysiology
血液性缺氧（hemic hypoxia）
由于血红蛋白数量减少或性质改变，使血氧含量 降低或血红蛋白释放氧不足，引起的供氧障碍
贫血
携带氧的数量减少
一氧化 原 碳中毒 因 高铁血
特点： 急性缺氧有效，伴有PaO2降低者明显
2019/10/23
病理生理学
呼吸功能障碍（损伤性变化）Pathophysiology
高原肺水肿
呼吸困难，咳嗽，血性泡沫痰 肺部有湿罗音，紫绀
缺氧引起血管收缩，回心血量增 加，肺血量急剧增加，肺毛细血 管压力升高
中枢性呼吸功能衰竭 呼吸抑制，通气量减少 PaO2过低
损伤性变化：RBC增多，血粘度增高，血流阻力增大， 心脏的后负荷增大，可促进心衰的发生。
2019/10/23
中枢神经系统
病理生理学 Pathophysiology
急性缺氧： 头痛，烦躁，记忆力下降，运动不协调
慢性缺氧： 疲劳，嗜睡，注意力不集中，抑郁
严重缺氧：
不安，惊厥，昏迷，死亡
机制：
发生于吸入一个大气压的氧8小时以后 症状：胸骨后疼痛、咳嗽、呼吸困难， PaO2↓，肺部炎性变。 (二）脑型氧中毒
发生于吸入2-3大气压以上的氧。 症状：视、听觉障碍、先抽搐、后昏迷。
2019/10/23
病理生理学 Pathophysiology
请预习
应激（Stress）
2019/10/23
②
2019/10/23
病理生理学 Pathophysiology
病理学 英文版ppt课件
Reperfusion
Neutrophil activation
ROS
Inflammatory Injury of mediators Micro-vessels
Cell injury
; No-reflow phenome2n5 on
Structural and Functional Changes
? Balloon angioplasty tachycardia
;
9
Mechanisms of Reperfusion Injury
↑Free radicals ↑Ca2+i
Neutrophil activation and Others
;
10
Free radical
Any atom or molecule possessing unpaired electrons
O2
;
Uric acid
14
Endothelial cell
Mechanism 3
Ischemia
Pro-inflammatory mediators (e.g. cytokines)
Reperfusion
O2
NO
O2-
ONOO-
;
15
(Respiration burst)
Biochemical Impacts of ROS
;
incubation medium4
;
5
Ischemic Injury of Neurons
0 hr
1 hr
6
Injury Windows
Ischemia
Injury Death
Time
Reperfusion
Neutrophil activation
ROS
Inflammatory Injury of mediators Micro-vessels
Cell injury
; No-reflow phenome2n5 on
Structural and Functional Changes
? Balloon angioplasty tachycardia
;
9
Mechanisms of Reperfusion Injury
↑Free radicals ↑Ca2+i
Neutrophil activation and Others
;
10
Free radical
Any atom or molecule possessing unpaired electrons
O2
;
Uric acid
14
Endothelial cell
Mechanism 3
Ischemia
Pro-inflammatory mediators (e.g. cytokines)
Reperfusion
O2
NO
O2-
ONOO-
;
15
(Respiration burst)
Biochemical Impacts of ROS
;
incubation medium4
;
5
Ischemic Injury of Neurons
0 hr
1 hr
6
Injury Windows
Ischemia
Injury Death
Time
Reperfusion
【英文课件-病理生理学】_弥散性血管内凝血-上海交通大学医学院学习
Malignancy tumours） Severe pancreatitis）
Snake bites）
■ ■
Diagnostic Criteria
（一）临床表现
1．存在易引起弥散性血管内凝血（DIC）的基础疾病 2．有下列两项以上表现。 （1）多发性出血倾向。 （2）不易用原发病解释的微循环衰竭或休克。 （3）多发性微血管栓塞的症状、体征，如皮肤、皮下、粘膜栓
四、纤溶抑制剂 (inhibitors application) 应用于DIC晚期，可同时并用小剂量肝素。
五、其他治疗 (others) 积极抗感染、抗休克、纠正酸中毒及电介质紊乱，加强局部止血等。
l 患者男性，25岁，因急性黄疸性肝炎入院。入院前10天，患者开始感到 周身不适，乏力，食欲减退，厌油、腹胀。5天来上述症状加重，全身 发黄而来院求治。
塞坏死及早期出现的肾、肺、脑等脏器功能不全。
（二）实验室检查
1．主要诊断指标：有下列3项以上异常： （1）血小板数低于100×109／L或呈进行性下降（肝病DIC时血小
板数低于50×109／L）。 （2）血浆纤维蛋白原含量＜1.5g/L或呈进行性下降（肝病DIC时＜
1g/L以下）。 （3）3P试验阳性或血浆FDP>20mg/L（肝病DIC时超过60mg/L)； （4）凝血酶原时间缩短或延长3秒以上，或呈动态变化；或活化的
DIC represents a continuum in clinical - pathologicalseverity, characterised by the increasing loss of localisationor compensated control in intravascular activation of coagulation.
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and anxiety.
■ Essential for initiating the HPA axis. （upward fibers of LC）
13
14
Neuroendocrine responses
Stress
Neuroendocrine responses to stress
Locus ceruleus-norepinephrine/ Sympathetic-adrenal medulla axis（LC-NE）
catecholamine (CA)↑
2．Stressor
The stimuli or agents that induce stress.
External factors
Cold, heat, toxins, drugs, bacteria, light.
Internal factors
Homeostasis, disease, cancer.
stressors
Neuroendocrine response + general adaptive reaction
CA, GC ↑
Cellular and humoral response
APP, HSP ↑
Functional and metabolic changes of
organs and systems
stress emergence reaction
9
Mimosa
10
Stress
3．Classification of stress response
Physical, chemical
Stress reaction
Physical stress
Psychological stress
Psycho-social factors
Stress
7-years student
刘承武
2012
1
Stress
OUTLINE
• Review • General response in stress • Cellular response in stress • metabolic and function changed in
stress
• stress and diseases
2
3
Stress
§1 Basic concepts of stress
■Stress ■Stressor ■Classification of stress response ■Significance of stress
4
Stress
1．Stress
11
Stress
4．Significance of stress
Defense and damnification are concomitance ，they are reciprocal transformation.
Defense: stress is a transmutation of organism adaptation, it can increase the body's readiness, and help the body fight or flight.
External or internal factors body systemic, non-specific adaptive reaction.
burn operation infection hypoxia Strong light noise
Definite intensity stimulate
Psychological, sociological factors
Work pressure, life rhythm, interpersonal relation
6
Stressor
Stress
7
8
organism
human animal plant ?
Higher organism Lower organism
■ If the stress is favor of the Fight or Flight under emergency
situation, Eustress ■ If the stressors are too strong cause pathology or even
death, Distress
(1) LC-NE components（central integrating and regulating）
pallium Emotional Limbic systemreaction
Paraventricular nucleus （PVN）
Social-psycho stress
Physical stimulation
Damnification: If stress is too strong or stimulate the body too long, it is harmful, and can lead to stressinduced diseases.
12
Stress
§2 General response in stress
Hypothalamic-pituitary-adrenal cortex system (HPA) activated
glucocorticoid (GC)↑
other hormonal responses to stress
15
Stress
1. Locus ceruleus - Norepinephrine （LC-NE）
pituitary
Cortex aTH
GC
LC
Medulla Adrenal gland
CA
16
Stress
(2) Basic effects of LC-NE
1）Center Effects ■ Cause emotions: excitement, awake, nervous
Specific reactions
necrosis fester
acidosis
non-specific reaction
Stress
anxiety dread blood reditribution HR ↑
No direct
association with original5
factors
Stress
■ Essential for initiating the HPA axis. （upward fibers of LC）
13
14
Neuroendocrine responses
Stress
Neuroendocrine responses to stress
Locus ceruleus-norepinephrine/ Sympathetic-adrenal medulla axis（LC-NE）
catecholamine (CA)↑
2．Stressor
The stimuli or agents that induce stress.
External factors
Cold, heat, toxins, drugs, bacteria, light.
Internal factors
Homeostasis, disease, cancer.
stressors
Neuroendocrine response + general adaptive reaction
CA, GC ↑
Cellular and humoral response
APP, HSP ↑
Functional and metabolic changes of
organs and systems
stress emergence reaction
9
Mimosa
10
Stress
3．Classification of stress response
Physical, chemical
Stress reaction
Physical stress
Psychological stress
Psycho-social factors
Stress
7-years student
刘承武
2012
1
Stress
OUTLINE
• Review • General response in stress • Cellular response in stress • metabolic and function changed in
stress
• stress and diseases
2
3
Stress
§1 Basic concepts of stress
■Stress ■Stressor ■Classification of stress response ■Significance of stress
4
Stress
1．Stress
11
Stress
4．Significance of stress
Defense and damnification are concomitance ，they are reciprocal transformation.
Defense: stress is a transmutation of organism adaptation, it can increase the body's readiness, and help the body fight or flight.
External or internal factors body systemic, non-specific adaptive reaction.
burn operation infection hypoxia Strong light noise
Definite intensity stimulate
Psychological, sociological factors
Work pressure, life rhythm, interpersonal relation
6
Stressor
Stress
7
8
organism
human animal plant ?
Higher organism Lower organism
■ If the stress is favor of the Fight or Flight under emergency
situation, Eustress ■ If the stressors are too strong cause pathology or even
death, Distress
(1) LC-NE components（central integrating and regulating）
pallium Emotional Limbic systemreaction
Paraventricular nucleus （PVN）
Social-psycho stress
Physical stimulation
Damnification: If stress is too strong or stimulate the body too long, it is harmful, and can lead to stressinduced diseases.
12
Stress
§2 General response in stress
Hypothalamic-pituitary-adrenal cortex system (HPA) activated
glucocorticoid (GC)↑
other hormonal responses to stress
15
Stress
1. Locus ceruleus - Norepinephrine （LC-NE）
pituitary
Cortex aTH
GC
LC
Medulla Adrenal gland
CA
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Stress
(2) Basic effects of LC-NE
1）Center Effects ■ Cause emotions: excitement, awake, nervous
Specific reactions
necrosis fester
acidosis
non-specific reaction
Stress
anxiety dread blood reditribution HR ↑
No direct
association with original5
factors
Stress