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Клиничкская Патофизиология: Осоновы=Clinical Pathophysiology Министерство здравоохранения Республики Беларусь УО «Витебский государственный ордена Дружбы народов медицинский университет» Беляева Л.Е. КЛИНИЧЕСКАЯ ПАТОФИЗИОЛОГИЯ: ОСНОВЫ Belyaeva L.Eu. CLINICAL PATHOPHYSIOLOGY: THE ESSENTIALS Пособие Рекомендовано учебно-методическим объединением по высшему медицинскому, фармацевтическому образованию Республики Беларусь в качестве пособия для студентов учреждений высшего образования, обучающихся по специальности 1-79 01 01 «Лечебное дело» Витебск 2018 УДК 616-092=111(07) ББК 52я73+54.1я73 B 41 Рекомендовано к изданию Центральным учебно-методическим советом ВГМУ в качестве пособия (25.10.2017 протокол № 9) Автор: Л.Е. Беляева Рецензенты: д.м.н., проф., чл.-корр. НАН Б, зав. каф. патологической физиологии Белорусского государственного медицинского университета Ф.И. Висмонт; кафедра патологической физиологии Гродненского государственного медицинского университета (зав. каф. – проф. Н.Е. Максимович) B 41 Клиническая патофизиология: основы = Clinical pathophysiology: the essentials : пособие / Л.Е. Беляева. – Витебск : ВГМУ, 2018. – 355 с. ISBN 978-985-466-932-8 В издании рассматриваются вопросы патофизиологии заболеваний основных систем организма, а также обсуждаются патофизиологические основы диагностики, профилактики и лечения заболеваний человека. Предназначено для студентов 3 и 4 курсов, изучающих дисциплины «Патологическая физиология» и «Клиническая патологическая физиология» на английском языке. УДК 616-092=111(07) ББК 73+54.1я73 ISBN 978-985-466-932-8 Оформление. УО «Витебский государственный медицинский университет» ABBREVIATIONS CD, cluster of differentiation (des- ignation) A CHD, coronary heart disease β-AR, β-adrenergic receptor CKD, chronic kidney disease ACE, angiotensin converting en- CK-MB, myoglobin isoenzyme of zyme creatine kinase ACTH, adrenocorticotropic hor- CNS, central nervous system mone CO, cardiac output AD, Alzheimer’s disease COPD, chronic obstructive pulmo- ADAMTS13, a disintegrin-like and nary disease metalloprotease with thrombos- COX, cyclooxygenase pondin type 1 repeats CRH, corticotropin-releasing hor- ADH, antidiuretic hormone mone ADPKD, autosomal dominant pol- CRP, C-reactive protein ycystic kidney disease CSA, central sleep apnea AGEs, advanced glycated end products D AIDS, acquired immunodeficiency 2,3-DPG, 2,3-diphosphoglycerate syndrome DAMPs, damage associated mo- ALS, amyotrophic lateral sclerosis lecular patterns ALT, alanine aminotransferase DDT, dichlorodiphenyltrichloro- Ang, angiotensin ethane ANP, atrial natriuretic peptide DHEA(S), dehydroepiandrosterone ANS, autonomic nervous system (sulfate) APCs, antigen presenting cells DIC, disseminated intravascular APT, activated partial thrombo- coagulation plastin time DM, diabetes mellitus ARDS, acute respiratory distress DMT, divalent metal transporter syndrome DOPA, 3,4-dihydroxyphenyl- ARF, acute renal failure alanine ARPKD, autosomal recessive pol- ycystic kidney disease E AST, aspartate aminotransferase ECG, electrocardiogram ATN, acute tubular necrosis EDLVP, end-diastolic left ven- tricular pressure B EDTA, ethylenediaminetetraacetic BP, blood pressure acid BUN, blood urea nitrogen EF, ejection fraction ELISA, enzyme-linked immuno- C sorbent assay CAH, congenital adrenal hyper- ENS, enteric nervous system plasia EPO, erythropoietin CBF, cerebral blood flow 3 ESR, erythrocytes’ sedimentation I rate IBDs, inflammatory bowel diseases ESRD, end stage renal disease IBS, irritable bowel syndrome ICAM-1, intercellular adhesion F molecule FDPs, fibrin degradation products IF, intrinsic factor FFAs, free fatty acids IFNγ, interferon-γ FGF, fibroblast growth factor IGF, insulin-like growth factor FSH, follicle-stimulating hormone IHD, ischemic heart disease FXR, farnesoid X receptor IL, interleukin INR, international normalized ratio G IQ, intelligence quotient GP, glycoprotein IRDS, infant respiratory distress γ-GTP, γ-glutamyl transpeptidase syndrome GABA, γ-aminobutyric acid IREs, iron regulatory elements GDH, glutamate dehydrogenase IRPs, iron regulatory proteins GERD, gastroesophageal reflux ITP, idiopathic thrombocytopenic disease purpura GFR, glomerular filtration rate I.V., intravenously GH, growth hormone GHRH, growth hormone-releasing L hormone LA, left atrium GIT, gastrointestinal tract LDH, lactate dehydrogenase GLP-1, glucagon-like peptide-1 LDL, low density lipoprotein GnRH, gonadotropin-releasing LDLR, low density lipoprotein re- hormone ceptor GSH, reduced glutathione LES, lower esophageal sphincter GSSG, oxidized glutathione LH, luteinizing hormone LOX, lipooxygenase H LOX, lipoxygenase 2+ Hct, hematocrit LTCC, L-type Ca current HDL, high-density lipoprotein LTs, leukotrienes HF, heart failure LV, left ventricle HIF, hypoxia-inducible factor HIV, human immunodeficiency vi- M rus MAC, membrane attack complex HMG-CoA, 3-hydroxy-3- MAO, monoamine oxidase methylglutaryl-CoA MCHC, mean cellular hemoglobin HR, heart rate concentration HSPs, heat shock proteins MCV, mean cellular volume HUS, hemolytic uremic syndrome MDH, malate dehydrogenase MEN, multiply endocrine neo- plasia 4 MHC, major histocompatibility PNS, parasympathetic nervous sys- complex tem MRP, multidrug resistance protein POMC, pro-opiomelanocortin MS, multiply sclerosis PPARγ, peroxisome proliferator activated receptors γ N PRL, prolactin NADH, nicotinamide adenine di- PRRs, pathogen-related receptors nucleotide (reduced) PT, prothrombin time NADPH, nicotinamide adenine di- PTH, parathyroid hormone nucleotide phosphate (reduced) NAFLD, non-alcohol fatty liver R disease RAAS, renin angiotensin aldoste- + 2+ NCX, Na /Ca exchanger rone system NF-Kβ, nuclear factor Kappa β RNS, reactive nitrogen species NK-cells, natural killer cells ROS, reactive oxygen species NMDA-receptors, receptors to the RBCs, red blood cells N-methyl-D-aspartate RyR, ryanodine receptor NO, nitric oxide NSAIDs, nonsteroidal anti- S inflammatory drugs SERCA, Ca2+-ATPase of the sar- NSTEMI, non-ST elevation myo- coplasmic reticulum cardial infarction SHBG, sex hormone binding glob- NYHA, New York Heart Associa- ulin tion SIAD, syndrome of inappropriate antidiuresis O SNS, sympathetic nervous system OSA, obstructive sleep apnea SR, sarcoplasmic reticulum STEMI, ST-elevation myocardial P infarction PAH, pulmonary arterial hyperten- SV, stroke volume sion SVR, systemic vascular resistance PAI, plasminogen activator inhibi- tor T PAMPs, pathogen associated mo- T3, triiodothyronine lecular patterns T4, tetraiodothyronine (thyroxine) PARs, protease-activated receptors TF, tissue factor PD, Parkinson’s disease TGF, transforming growth factor PDGF, platelet derived growth fac- TIA, transient ischemic attack tor TLRs, Toll-like receptors PGs, prostaglandins TNF, tumor necrosis factor PL A2, phospholipase A2 TRH, thyrotropin-releasing hor- PMNs, polymorphonuclear neutro- mone phils TSH, thyroid-stimulating hormone 5 TTP, thrombotic thrombocytopenic purpura TX A2, thromboxane A2 U UDP-GT, uridine diphosphate- glucuroniltransferase UMP-GT, uridine monophosphate- glucuroniltransferase V VCAM-1, vascular cellular adhe- sion molecule-1 VEGF, vascular endothelial growth factor VIP, vasointestinal peptide VLDL, very low density lipopro- tein vSMCs, vascular smooth muscle cells vWF, von Willebrand factor W WBCs, white blood cells WHO, World Health Organization 6 CONTENTS Pages PART I. Pathophysiology of the blood 8 1. Red blood cells disorders 8 2. White blood cells disorders 38 3. Bleeding disorders 51 PART II. Pathophysiology of the cardiovascular system 63 1. Heart failure 63 2. Atherosclerosis. Ischemic heart disease 80 3. Disorders of regulation of vascular tone. Arterial hypertension. 107 Arterial hypotension PART III. Pathophysiology of the respiratory system 129 PART IV. Pathophysiology of the gastrointestinal tract and 161 exocrine pancreas PART V. Pathophysiology of the liver 201 PART VI. Pathophysiology of the kidneys 232 PART VII. Pathophysiology of the endocrine system 265 PART VIII. Pathophysiology of the nervous system 318 SUPPLEMENT 350 BIBLIOGRAPHY CITED 355 7 PART I. PATHOPHYSIOLOGY OF THE BLOOD 1. RED BLOOD CELLS DISORDERS Changes of the total blood volume Blood consists of a protein-rich fluid (plasma) and cellular elements (red blood cells, RBCs, white blood cells, WBCs, and platelets). The normal total circu- lating blood volume is about 8% of the body weight. The percentage of blood cells in the blood after blood sample centrifuging in a specialized tube is termed as hematocrit (Hct). For normal persons hematocrit is approximately 40-45%. Classi- fication of blood volume disorders is presented in the Fig. 1-1. Figure 1-1. Blood volume disorders Hypervolemia is defined as an increasing of the total blood volume. Simple hypervolemia is characterized by unchanged Hct. Causes: transient state after a transfusion of a significant volume of the whole blood; intensive physical activity followed by translocation of the interstitial fluid and deposited blood in the blood vessels. Oligocytemic hypervolemia is a result of an increasing of the plasma volume. Hct is decreased. Causes: disorders of kidneys, resolution of severe edema, transfusion of the crystalloids and colloids. Policytemic hypervolemia is a result of an increasing total blood volume due to elevation of the red blood cells count. Hct is increased. Causes: mountain sickness, cardiac malformations (as a compensatory reaction in response to hypoxia), chron- ic myeloproliferative disorders. Hypovolemia is a decreasing the total blood volume. Simple hypovolemia is characterized by unchanged Hct.
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