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Pathophysiology PATHOPHYSIOLOGY Basic overview for medical students 1st revised (only electronic) version MIROSLAV KUBA, ZUZANA KUBOVÁ Department of Pathophysiology Charles University - Faculty of Medicine in Hradec Králové Czech Republic Hradec Králové, October 2018 Preface to the revised version After 13 years from the 1st edition of our lecture notes a new textbook could be written on the basis of many scientific novelties - discoveries/hypotheses in Pathophysiology and related fields that appeared in the meantime. But since our „basic overview” of Pathophysiology is oriented to medical students, we believe that the main principles of this textbook can stay the same as they are explained in the Introduction to the 1st issue. It means that we intentionally do not ad too much new information but we have rather revised the text according to the feedback from side of students. We tried to focus still more to important logic of relationships between single facts for better understanding of mechanisms of diseases, in particular of those which can lead to death. We namely believe that despite the modern tendency to introduce clinical guidelines (which are only mechanically followed by doctors), students should understand well the background of diseases!!!. It can be very individual and thus, standard using of clinical guidelines can be quite danger in a distinct proportion of patients. Therefore, we try to instruct students to be enough self-confident about their ability to recognise important relationships for the correct diagnosis and optimal (individualized) treatment. This is not the definite version for the second (printed) issue of our Pathophysiology, we will still continue in the upgrade but now we would like to provide a newer version to our current 3rd year medical students. Hradec Králové, October 2018 Miroslav Kuba Zuzana Kubová 2 Contents Preface to the revised version .............................................................................................................. 2 1. Organism and environment, adaptation ........................................................................................... 6 2. Health versus disease, Etiology and Pathogenesis, Clinical and biological (somatic) death ........... 8 3. Immunodeficiencies ....................................................................................................................... 11 4. Allergies ......................................................................................................................................... 12 5. Autoimmune disorders, post-transplantation reaction ................................................................... 14 6. Neoplasia, neoplasm-host interaction (effects) .............................................................................. 15 7. Alterations in fluid volume ............................................................................................................ 18 8. Disorders of osmolarity, etiology and pathogenesis of edema ...................................................... 21 9. Hyponatremia, hypernatremia ........................................................................................................ 24 10. Hypokalemia, hyperkalemia ........................................................................................................ 26 11. Importance of Iron, Iodine and other Trace elements .................................................................. 29 12. Disorders of Calcium, Phosphorus and Magnesium metabolism ................................................ 31 13. Osteoporosis, Osteomalacia, Renal Osteodystrophy ................................................................... 36 14. Pathophysiology of Cramps ......................................................................................................... 37 15. Acidosis ........................................................................................................................................ 38 16. Alkalosis....................................................................................................................................... 45 17. Disorders of peripheral circulation .............................................................................................. 48 18. Syncope ........................................................................................................................................ 51 19. Circulatory shock ......................................................................................................................... 53 20. Inflammation ................................................................................................................................ 55 21. Sepsis, Systemic Inflammatory Response Syndrome (SIRS) ...................................................... 58 22. Pathophysiology of pain............................................................................................................... 59 23. Fever, Hyperthermia .................................................................................................................... 62 24. Hypothermia and Reaction of organism to cold .......................................................................... 65 25. Stress, General adaptation syndrome ........................................................................................... 66 26. Psychosomatic diseases ................................................................................................................ 67 27. Anemias – classification .............................................................................................................. 68 28. Anemias – consequences ............................................................................................................. 69 29. Blood transfusion, complications, fetal erythroblastosis ............................................................. 70 30. Leukemias, lymphomas ............................................................................................................... 72 31. Myeloma (monoclonal gammopathy) .......................................................................................... 74 32. Polycythemia ................................................................................................................................ 75 33. Bone marrow depression .............................................................................................................. 76 34. Disorders of hemostasis and coagulation ..................................................................................... 77 35. Thrombophilic states, DIC ........................................................................................................... 81 36. Dyslipoproteinemia ...................................................................................................................... 84 3 37. Endothelial dysfunction, effects of nitric oxide ........................................................................... 86 38. Atherosclerosis ............................................................................................................................. 88 39. Arterial hypertension.................................................................................................................... 90 40. Arterial hypotension ..................................................................................................................... 92 41. Disorders of cardiac rhythm and conduction ............................................................................... 93 42. Ischemic heart disease .................................................................................................................. 95 43. Myocardial infarction and its complications ................................................................................ 97 44. Congenital Heart Defects ............................................................................................................. 99 45. Acquired Valvular Heart Defects ............................................................................................... 100 46. Heart failure ............................................................................................................................... 102 47. Compensatory mechanisms in heart failure ............................................................................... 105 48. Pulmonary circulation, ventilation/perfusion ratio, gas diffusion disorders .............................. 107 49. Obstructive respiratory diseases ................................................................................................. 110 50. Restrictive pulmonary diseases .................................................................................................. 112 51. Pulmonary hypertension, pulmonary edema .............................................................................. 116 52. Adult respiratory distress syndrome - ARDS ............................................................................ 118 53. Respiratory Failure ..................................................................................................................... 119 54. Hypoxia ...................................................................................................................................... 121 55. Hyperoxia, hyperbaria, decompression ...................................................................................... 123 56. Nephritic syndrome ...................................................................................................................
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