Serial number of course:
Course Name: Pathophysiology
Type: Compulsory course
Targets：International student
Duration: 120 hours
Credit: 12
Teaching Dept: Dept. of Pathophysiology
Writer: Li Yang, Sun Liankun, Li Hongyan

Objective:

Pathophysiology is a basic course of medical theory, and it studies the mechanisms of disruptive homeostasis that progresses beyond the normal compensatory capabilities of the human body. Pathophysiology is a science concerning the etiology and pathogenesis of diseases, and the underlying mechanism of functional and metabolic alterations in diseases. All essential aims of pathophysiological course are:

• To lead interesting in the study of Pathophysiology;
• To understanding of pathophysiological concepts, etiology, pathogenesis and processes of diseases;
• To promote an awareness and appreciation of the significance of pathophysiological knowledge in personal, social, basic and clinical medicine contexts;
• To promote an appreciation of the importance of experimental and investigatory work in the study of pathophysiology;
• To develop observational, manipulative, and experimental skills;
• To provide a suitable preparation for further studies in the pathophysiology and related disciplines.

Contents:

Chapter 1 Conspectus of Disease
Objective

• To mastering the concept of disease, and to understanding the basic pathological process;
• To understanding the concept of etiology,
• Being familiar with cause of disease, predisposing factors and precipitating factors;
• To understand the concept of pathogenesis;
• To understand disruption of homeostasis, process of damage and anti-damage, the reversal role of cause and result, Correlation between systemic and local regulations;
• To understand the neural, humoral, cellular, and molecular mechanisms of disease and concept;
• To master the concept of complete recovery, incomplete recovery and brain-death;
• To master the criteria of brain death;

Teaching contents

• Concept of Disease
• Etiology of disease
• Pathogenesis of Disease
• Outcome of Disease

Experiment
Guides for manipulation of laboratory animals

Chapter 2 Disorders of Water and Electrolyte Metabolism
Objective

• To learn the volume, distribution, composition and osmolality of body fluid.
• To understand mechanisms for regulation body fluid and electrolyte balance.
• To master the meaning of hyponatremia, including hypovolemic hyponatremia (hypotonic dehydration), hypervolemic hyponatremia (water intoxication), and normovolemic hyponatremia. To master the alternation of metabolism and function when it occurred. To know the etiology and pathogenesis and pathophysiological base of prevention and treatment.
• To master the meaning of hypernatremia, including hypovolemic hypernatremia (hypertonic dehydration), hypervolemic hypernatremia, and normovolemic hypernatremia. To master the alternation of metabolism and function when hypovolemic hypernatremia occurred. To know the etiology and pathogenesis and pathophysiologic base of prevention and treatment.
• To learn the meaning of isotonic dehydration.
• To master the concept of edema and its basic mechanism(imbalance of fluid interchange between plasma and interstitial compartment, and the renal retention of sodium and water. To understand the characteristics of edema and the concept of exudates, transudates.
• To understand potassium metabolism
• To master the concept of hypokalemia (potassium depletion). To understand etiology and pathogenesis of hypokalemia. To master effects of hypokalemia on the neuromuscular irritability and heart.
• To master the concept of hyperkalemia. To understand etiology and pathogenesis of hyperkalemia. To master effects of hyperkalemia on the neuromuscular irritability and heart.
• To understand disorders of magnesium metabolism
• To understand disorders of calcium and phosphorus metabolism.

Teaching contents

• Body fluid and electrolyte balance
• Disorders of Water and Sodium Metabolism
• Disorders of Potassium Metabolism
• Disorders of Magnesium Metabolism
• Disorders of Calcium and Phosphorus Metabolism

Experiment
Animal model with edema and discuss the mechanism of edema

Chapter 3 Acid-Base Balance and Disturbances
Objective

• To understand the generation of acids and bases and regulation of pH.
• To understand the concept of pH, PaCO2, HCO3-, AG and their significance.
• To master the concept, and changes of parameters of metabolic acidosis. To understand the cause, compensation regulation and systemic dysfunction related with metabolic acidosis.
• To master concept, compensation regulation and changes of parameters of respiratory acidosis. To understand primary causes of respiratory acidosis occurred.
• To master the concept, and changes of parameters of metabolic alkalosis. To understand the cause, compensation regulation and systemic dysfunction related with metabolic alkalosis.
• To master concept, compensation regulation and changes of parameters respiratory alkalosis. To understand the cause, compensation regulation and systemic dysfunction related with respiratory alkalosis.
• To master the judgment and analysis of simple acid-base disorders, including the use of the compensation formula.
• To understand double acid-base disturbances.

Teaching contents

• Acid-base biochemistry and regulation of pH.
• Essential Parameters and Significance of Acid-Base Balance
• Simple Types of Acid-Base Disturbance
• Mixed Acid-Base Disturbances

Experiment
no

Chapter 4 Hypoxia
Objective

• To master the concept of hypoxia.
• To understand parameters of blood oxygen and theirs significance.
• To master the concept of hypotonic hypoxia, hemic hypoxia, circulatory hypoxia, histogenous hypoxia. To grasp alterations of blood oxygen parameters and the mechanism of tissue hypoxia.
• To master the cause of hypoxia.
• To understand functional and metabolic disturbances of respiratory system, circulatory system and hemic system.
• To learn the change of central nerve system and cellular alterations
• To learn factors involved in tolerance to hypoxia
• To learn oxygen treatment and oxygen toxicity

Teaching contents

• Parameters of Blood Oxygen.
• Classification, Etiology and Pathogenesis of Hypoxia
• Functional and Metabolic Changes Resulted with Hypoxia
• Factors Affecting the Tolerance to Hypoxia
• Oxygen Therapy and Oxygen Toxicity

Experiment
Animal model of rabbits with hypotonic hypoxia

Chapter 5 Fever
Objective

• To master the concept of fever
• To understand the exogenous pyrogens (emphasis on bacteria endotoxins)
• To master the concept of endogenous pyrogens. To understand the classification and characteristics of endogenous pyrogens.
• To learn the thermoregulation center, to master the function of pyrogenic signals on thermoregulation center and central mediators, including positive and negative regulation mediators
• To master fever stages and the metabolism and function change body.
• To learn advantages and disadvantages of fever.

Teaching contents

• To understand the concept of hyperthermia and classification in pathological elevations of body temperature.
• Etiology and Pathogenesis of Fever
• Thermoregulation of Fever
• Metabolism and Function Change
• Pathophysiological Basis of Prevention and Treatment

Experiment
no

Chapter 6 Dysfunction of cell signaling in diseases
Objective

1. To understand major pathways for cell signaling. To master the concept of ligand and receptor.
2. To master G protein signal pathway. To understand tyrosine protein signal pathway. To understand guanylyl cyclase signal pathway.
3. To learn intracellular and nuclear receptor signal pathway.
4. To learn the aberrant signal molecules in diseases.
5. To master the aberrant receptors in diseases, including receptor gene mutation and secondary receptor deficit.
6. To learn the aberrant G-protein in diseases.
7. To learn the aberrant intracellular signaling in diseases,
8. To learn the multiple signaling aberrations in diseases. To master mechanism of cell signaling aberrations due to ligand and receptor disorders. To learn the mechanism of tumor, cardiovascular diseases.
9. To understand the relationship between stimulants and pathological effects.

Teaching contents

1. Introduction of Signal Transduction System
2. Dysfunction of Cell Signaling in diseases

Experiment
no

Chapter 7 Cell proliferation, differentiation, apoptosis and the related diseases
Objective

1. To understand cell cycle, its control system and its specific checkpoints, and cell proliferation control by extracellular signal.
2. To understand deregulation of cell proliferation and diseases.
3. To understand control factors of cell differentiation, it includes intracellular regulators, DNA methylation and extracellular factors. To learn relationship between cell differentiation and tumor.
4. To master the concepts of apoptosis, to understand factors related with cell apoptosis.
5. To understand relation of abnormal cell apoptosis with tumors, autoimmune diseases and heart failure.

Teaching contents

1. Cell proliferation and diseases
2. Cell differentiation and diseases
3. Cell Apoptosis and diseases

Experiment
no

Chapter 8 Stress and stress-related diseases
Objective

1. To master the concept of stress
2. know the classification of stressor
3. To understand the concept, stages and manifestations of general adaptation syndrome
4. To understand neuroendocrine responses to stress (mainly the locus ceruleus norepinephrine neurons sympathetic / adrenal medulla axis, hypothalamus pituitary adrenal cortex axis and hormones). To learn other endocrine responses.
5. To master the concept of acute phase protein (AP). To understand biological function of AP, to learn the components and sources of AP.
6. To master the concept of heat shock protein (HSPs). To learn the basic components and basic function of HSPs.
7. To learn metabolism and function changes of stress onto body.
8. To master the concept and mechanism of stress ulcer, to learn the relation of stress with cardiovascular disturbances, endocrine disturbances, gonadal axis disturbance, psychosocial disturbance.

Teaching contents

1. Introduction
2. General Respond of Stress
3. Cellular and Humoral Responses
4. Functional and Metabolic Responses of Body
5. Stress -related Diseases

Experiment
Animal model of stress diseases and discuss the mechanism of stress diseases

Chapter 9 Coagulation-anticoagulation balance and imbalance of haemostatic system
Objective

1. To master mechanism of DIC
2. know the causes of DIC
3. To understand predisposing factors to DIC
4. To learn stages and types of DIC
5. To master mechanism of bleeding of DIC (especially FDPs).
6. To understand mechanism of shock and anemia
7. To learn dysfunction of multiple organs

Teaching contents

1. Etiology and Mechanism of DIC
2. Predisposing Factors to DIC
3. Stages and Types of DIC
4. Functional and Metabolic Changes of DIC

Experiment
no

Chapter 10 Shock
Objective

1. To master the concept of shock and to learn the history of shock
2. To understand the classification of shock.
3. To master the change of microcirculation and tissue blood volume in ischemic anoxia stage, the mechanism of microcirculation disorders. To understand the compensative significance of microcirculation changes. To learn clinical manifestation.
4. To master the change of microcirculation and tissue blood volume in stagnant hypoxia stage, the mechanism of stagnant microcirculation. To understand outcome of decompensate stage. To know clinical manifestation.
5. To master mechanism of organic failure stage. To learn MODS.
6. To understand the roles of catecholamine and angiotensin, cytokines, adhesion molecules, and endothelium-derived vasoactive mediators, activation of complement cascade, lysosomal enzymes and redox imbalance on pathogenesis of shock. To learn changes of various organ and system.
7. To master the concepts of MODS, SIRS, CARS and MARS
8. To understand mechanism etiology and mechanism of MODS.
9. Etiology and Classification of Shock
10. Stages of Shock and their pathological changes
11. Roles of Humoral Factors in Pathogenesis of Shock
12. Multiple Organ Dysfunction Syndrome

Experiment
Establishment of animal model of hemorrhagic shock and application of anti-shock medicine.

Chapter 11 Ischemia-reperfusion injury
Objective

1. To learn Ischemia-reperfusion Injury influence factors of Ischemia-reperfusion Injury
2. To master injury of free radicals, it includes generation of free radical, alterations induced by oxygen free radicals
3. To master mechanism of calcium overload
4. To learn the relation of endothelial injury with neutrophil activation
5. To learn myocardial, cerebral, hepatic and renal Ischemia-reperfusion Injury

Teaching contents

1. Etiology of Ischemia-reperfusion Injury
2. Mechanisms of Ischemia-reperfusion Injury
3. Alterations of function and metabolism during Ischemia-reperfusion Injury

Experiment
no

Chapter 12 Heart failure
Objective

1. To master the concept of heart failure
2. To learn etiology, pathogenesis and classification of heart failure
3. To learn normal systolic-diastolic function of myocardial cell
4. To master mechanisms of decreased myocardial contractility, it includes damaged cardiomyocyte, metabolic dysfunction of myocardium, dysfunction of excitation- contraction coupling and excessive myocardial hypertrophy.
5. To master mechanisms of iastolic dysfunction, and this includes delayed reposition of Ca2+, impaired dissociation of the actin-myosin complex, decreased ventricular diastolic potential and reduced ventricular compliance.
6. To learn asynergic myocardial contraction and relaxation
7. To understand the mechanism of compensatory respond of heart(including heart beat increase, hypertrophy), extrocardial compensatory respond (especially blood volume increase)
8. know compensatory of nerve-body fluid
9. To understand the concept and mechanism of dyspnea, prthopnea and paroxysmal nocturnal dyspnea. To understand mechanism of pulmonary edema
10. To learn manifestation of systemic circulation congestion
11. To learn manifestation of decreased cardiac output

Teaching contents

1. Introduce
2. Pathogenesis of Heart Failure
3. Etiology, Pathogenesis and Classification of Heart Failure
4. Compensatory Respond of Heart Failure
5. Clinical Manifestation of Heart Failure

Experiment
Animal model duplication and pathogenesis of acute cardiac failure.

Chapter 13 Respiratory Failure
Objective

1. To understand the concept and cause of restrictive hypoventilation. To understand the concept of obstructive hypoventilation. To understand main factors to obstruct airway and manifestation of dyspnea. To master the alteration of blood gas
2. To master the concept and causes of diffusion disorders and the alteration blood gas
3. To master the types and causes of ventilation-perfusion imbalance and the alteration of blood gas
4. To master the concept of true shunt and grasp the way of diagnosis functional shunt and true shunt.
5. To master the concept of ARDS (acute respiratory distress syndrome). To master mechanisms of acute lung injury in ARDS
6. To understand disorders of water and electrolyte metabolism, acid-base disturbances, alterations of respiratory system and cardiovascular system in respiratory failure
7. To master the concept and mechanism of pulmonary encephalopathy
8. To learn alteration of renal function and gastrointestinal function in respiratory failure

Teaching contents

1. Etiology and Mechanism
2. Main Metabolism and Function Disturbance

Experiment
Animal model duplication and pathogenesis of acute respiratory failure

Chapter 14 Hepatic Failure
Objective

1. To learn the etiology and classification of hepatic failure
2. To learn mechanism of hepatic insufficiency
3. To master the concept of hepatic encephalopathy, and its comprehend stages
4. To master the cause of ammonia increasing. To master the mechanism of ammonia intoxication.
5. To master the concept and mechanism of false neurotransmitter and amino acid imbalance.
6. To master the source and GABA and GABA hypothesis.
7. To learn some new viewpoints about hepatic encephalopathy.
8. know precipitating factors of hepatic encephalopathy
9. To understand pathogenesis of hepatorenal syndrome

Teaching contents

1. Etiology and Classification
2. Mechanism of Hepatic Insufficiency
3. Hepatic Encephalopathy
4. Hepatorenal Syndrome

Experiment
no

Chapter 15 Renal Failure
Objective

1. To understand dysfunction of glomerular filtration, this includes decrease of renal blood flow, glomerular effective filtration pressure, glomerular capillary surface area and alterations of permeability of glomerular filtration member.
2. To understand renal tubular dysfunction, and this includes dysfunction of the proximal convoluted tubules, henle’s loop, and the distal convoluted tubules and collecting ducts.
3. To understand renal endocrine dysfunction, this includes activation of rennin- angiotensin aldosterone system, decreased EPO and etc.
4. To master the concept of acute renal failure
5. To learn cause and types of acute renal failure
6. To understand the process of oliguric acute renal failure (initial phase, oliguria phase, diuresis phase). To understand mechanism of oliguria phase.
7. To master mechanism of initial phase.
8. To understand the cause of azotemia, metabolic acidosis, hyperkalemia in initial phase.
9. To learn mechanisms of renal cell injury
10. To understand the concept of chronic renal failure
11. To learn the cause of chronic renal failure
12. To learn the process and mechanism of chronic renal failure
13. To master the concept of azotemia, mechanism of phosphate and calcium metabolism dysfunction and metabolic acidosis, mechanism of renal hypertension, renal anemia, renal osteodystrophy
14. To learn the manifestation of urinal dysfunction in chronic renal failure
15. To learn disorders of sodium metabolism, potassium metabolism, and hemorrhagic tendency
16. To master the concept of uremia
17. To learn alteration of function and metabolism and mechanism of uremia

Teaching contents

1. Basic Pathological Taches for Renal Failure
2. Acute Renal Failure
3. Chronic Renal Failure
4. Uremia

Experiment
no

Chapter 16 Brain Dysfunction
Objective

1. To learn structural basis of cognition
2. To understand major manifestation of cognitive disorders
3. To learn etiology and pathogenesis of chronic brain damage
4. To master the concept of consciousness disorder and its etiology and pathogenesis
5. To understand systemic disturbance caused by consciousness disorder

Teaching contents

1. Cognitive disorders
2. Consciousness disorder

Experiment
no

The basic teaching request of the curriculum:

1. Teaching methods: Oral presentation, multimedia and traditional writing on the blackboard in class. especially for conception。
2. Under the guidance of teachers, students should to master the basic operating skills of pathophysiological experiments, complete the experiments independently according to the practice instruction, and write the laboratory reports.
3. Based on this state above, students should design the experiments by themselves or accomplish large-scale, synthetically, and scientific experiments. Therefore, students are able to meet scientific research, and understand the procedure of scientific work and the way in which the scientific ideas can be developed.
4. Examination: Final close-paper examination (60%) adopted to test the theoretical contents. Experiment examination (40%) derived from laboratory reports, laboratory paper and presence of student. The aim of the examination focused on the development of ability.

Relationship with Other Course
When students study <pathophysiology>, first, they need study <physiology> and <biochemistry>, than, they study clinical course, such as <internal medicine>, <surgery>, <pediatrics>, <obstetric-gynaecology>.
Reference books:
Textbook:?
Pathophysiology, First edition, Chen Zhuchu chief editor, people’s medical publishing house
Reference:

1. Pathophysiology, Wan Dixun chief editor , people’s medical publishing house
2. Pathophysiology, Yang Huiling chief editor , science publishing house
3. Pathophysiology, Wu Qixia chief editor, XieHe University of Medical Science publishing house.
4. Pathophysiology Course, Zhang Qiliang chief editor, science and technique publishing house of shanghai
5. Pathophysiology Experiment Guide, Guo Zhongyu chief editor, Norman Bethune university of medical science.

Please note that the above syllabus is tentative and subject to change.