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Last update: doc. MUDr. Hana Maxová, Ph.D. (22.10.2018)
Guyton, A. C.: Textbook of medical physiology : W. B. Saunders company, 2006 (B), (avaible as ebook)
McPhee,S.J.; Hammer G.D.:Pathophysiology of disease 6th edition: Mc Graw-Hill, 2010
+Kaufman, Ch. E.: Essentials of pathophysiology : Little, Brown and Company, 1996 (B)
Schmidt, R. F.: Physiologie des Menschen mit Pathophysiologie: Springer-Lehrbuch, 2007
Damjanov, I.: Pathophysiology: Saunders Elsevier, 2009 |
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Last update: doc. MUDr. Hana Maxová, Ph.D. (31.08.2021)
SYLABUS OF PATHOLOGICAL PHYSIOLOGY modified, valid from 2019/2020
GENERAL Health, illness, death – definition, symptom/syndrome/disease, stages of a disease, extrinsic and intrinsic causes of diseases, clinical and biological death, signs of brain death Disorders of temperature control – fever, hyperthermia and its consequences, hypothermia and reaction of the body Edema – Starling forces, generalized (heart failure, hypoproteinemia) versus localized (inflammatory, venostatic, lymphostatic) Concrements, colic - concrement formation (types, saturation of fluid, AB balance), characteristics of different types of colic and their propagation, other consequences of concrements Icterus – causes (prehepatal, hepatal, posthepatal), diagnostics, complication Acidosis – metabolic, respiratory, causes, compensation, consequences (influence on ICF) Alkalosis - metabolic, respiratory, causes, compensation, consequences (influence on ICF) Hyperhydration – iso/hyper/hypo-osmolar, causes, consequences (lung and brain edema) Dehydration – iso/hyper/hypo-osmolar, causes, consequences (blood viscosity, hypovolemic shock) Disorders of K+ and Cl- metabolism, relation to AB balance – causes, ICF/ECF, resting membrane potential, arrhythmias, sceletal muscles Disorders of Ca, P metabolism - parathyroid glands, relation between Ca and P, parathormon, vitamin D, calcitonin, causes and consequences (tetany, calcifiation) Classification of hypoxias – hypoxic, ischemic, anemic, histotoxic, diffusion distance Intoxication – CO, kyanids, nitrates, organophosphates, botulism, alcohol, methanol, paracetamol, amanitin, faloidin, salicyláty, digitalis, atropin AB balance testing – pH, respiratory (CO2) and metabolic component (BE, HCO3-), AG, Cl-corr, principals of blood sampling and measurement
BLOOD Anemic syndrome – symptoms (paleness, fatigue, dyspnea), compensatory mechanisms Anemias caused by erytrocytes loss - chronic posthemorrhagic (causes – GIT, urogenital system), hemolytic (causes), lack of iron, chronic disease anemia (hypersplenism, renal insufficience, liver, tumors) Anemias caused by impaired hematopoesis – bone marrow disorders, erytropoetin, Fe, B12 Hyperviscosity – causes (polyglobulia, CML, paraprotein), symptoms (CNS, heart, cyanosis, thrombosis/bleeding) Disorders of hemostasis – conditions related to hypercoagulation or bleeding diathesis, innate and acquired disorders DIC – causes, pathogenesis and consequences Hematologic testing - complete blood count, morfologic classification of anemia, percentages of the types of WBCs, erythrocyte sedimentation rate, tests of hemostasis (Quick, aPTT)
CIRCULATION Pathophysiology of arteries – narrowing and obstruction, aneurysms, atherosclerosis (pathogenesis, symptoms) Pathophysiology of cappilaries and veins – edemas, specific features of venous flow, thrombosis (deep venous thrombosis, thrombophlebitis), chronic venous insufficiency, varixes, embolism Primary arterial hypertension – mechanisms of BP regulation, BP values, decreased compliance of large arteries, causes (CO, kidneys, sympaticus, endothelium), consequences, principals of therapy Secondary hypertension – renal (parenchyma, renovascular), endocrine (types), hypertension during pregnancy Hypovolemic shocks, compensatory mechanisms – types, stages of shocks, compensatory mechanisms and circulation failure causes, organ consequences, principles of therapy Distributive shocks – septic, anaphylactic, neurogenic, causes of vasodilation (NO), principles of therapy Acute heart failure – factor influencing CO, left/right side failure, causes, cardiogenic shock, central venous pressure, symptoms, diagnostics (EF, CVP), principles of therapy Chronic heart failure – classification of heart failure, causes, compensatory mechanisms (Frank-Starling´s law), molecular mechanisms, principles of therapy Disorders of coronary circulation, clinical forms of ischemic heart disease – determinants of myocardial oxygen supply, coronary bed flow, causes, acute coronary syndrome and chronic forms of IHD Acute myocardial infarction – causes, consequences of coronary flow arrest, symptoms, principles of diagnostics (ECG, laboratory findings) and therapy, life threatening complications of MI Hemodynamics of valvular defects – causes of valvular defects, volume and pressure overload, consequences (heart failure, pulmonary hypertension) Hemodynamics of congenital heart defects – without shunt (coarctation), with shunt (septal defects, PDA, Fallot´s tetralogy), factors influencing hemodynamics Disturbances of impulse conduction in the heart and cardias arrhythmias, including ECG findings – causes (disturbances of AP conduction - blocks, ectopic AP generation, reentry), consequences, principles of therapy Testing of cardiovascular system – BP, ECG, echocardiography, Holter monitoring, myocardial perfussion scintigraphy, ergometry (ischemia, anaerobic treshold) Characteristics of pathological ECG recordings - myocardial hypertrophy, ischemic changes, ions imbalance - K+ and Ca2+
KIDNEY Disturbances of renal blood flow – causes of decreased and increased renal blood flow, consequences, autoregulation and its changes Disorders of glomerular filtration – quantitative and qualitative Disorders of tubular transport – innate and acquired, symptoms and consequences(ability to concentrate, ions imbalace, AB balance) Nephrotic and nephritic syndrome – patogenetic mechanisms and symptoms, consequences, principles of therapy Acute renal failure – causes (prerenal, renal, postrenal), phases (oliguric, polyuric), consequences (disturbances of ECF, ions, AB balance, uremia) Chronic renal failure - causes, consequences, compensatory mechanisms, chronic cardiorenal and renocardial syndrome, hepatorenal syndrome Disorders of urinary tract – incontinence, urine retention, vesikoureteral reflux, urolithiasis Dialysis: principles and effect – hemodialysis and peritoneal dialysis, principles, indications, advantages and disadvantages Testing of renal function – urinalysis (casts, protein, hematuriy, glucose), GFR and eGFR, fractional excretion, ability to concentrate, urodynamic tests
RESPIRATION Changed compliance of lung and respiratory system - causes, consequences – components of lung compliance (elasticity, surface tension), static and dynamic measurement, work of breathing, atelectasis Changed airway resistance – factors affected airway resistance, extrathoracic and intrathoracic (air trapping, equal pressure point), consequencesof increased airway resistance (work of breathing, V/Q) Pneumothorax – causes, classification, consequences (tension type), mechanism of reabsorption, therapy Defense lung reflexes – sneezing, protective apnoea, cough (causes, complications) Control of breathing in respiratory diseases - ventilatory response to hypoxia and hypercapnia – central and peripheral receptors, izoventilatory response, changed respiratory regulation in chronic hypercapnia, pathologic respiratory patterns (Cheyne-Stokes´, Biot´s, Kussmaul´s) Disturbances of alveolar ventilation, respiratory insufficiency – hypo- and hyperventilation, causes, consequences - respiratory insufficiency (partial/global, latentn/manifest), AB dysbalance, tetany, dyspnea Hypobaria, hyperbaria – adaptation to life in high mountains, high altitude sickness, pulmonary and brain edema, chronic high altitude sickness, nitrogen narcosis, decompression sickness Artificial ventilation, oxygenotherapy – volume or pressure controled, assist-control mode, PEEP, high frequency oscillatory ventilation, ways of oxygen administration, hyperbaric, side effects Inequalities of ventilation-perfusion ratio – physiologic non-uniformity, hypoxic pulmonary vasoconstriction, causes of unequal ventilation and perfusion, consequences (venous adózní příměs, alveolární mrtvý prostor) Diffusion impairment, lung edema – diffusion path prolongation, decrease of diffusion area, transfer factor, interstitial and alveolar lung edema, its causes and consequences Pulmonary embolism – causes, consequences according degree of embolism (acute, chronic), diagnostics, principles of therapy Pulmonary hypertension – causes of increased pulmonary resistance, types (precapilar, postcapilar, hyperkinetic), impact on vascular morphology, principles of therapy Bronchial asthma – changed mechanics of breathing, paroxysmal obstruction (air trapping, equal pressure point), causes (bronchial hyperreactivity), eosinophilic inflammation, consequences (hypoxemia, cor pulmonale, status astmaticus), principles of therapy Obstructive pulmonary diseases, especially COPD – changed mechanics of breathing, pathogenesis of emphysema and bronchitis, clinical forms (pink puffers, blue bloaters), principles of therapy Restrictive pulmonary diseases – pulmonary fibrosis, pneumonia, RDS, ARDS – causes nad consequences of restriction (mechancs of breathing, pulmonary hypertension), patophysiology of ARDS a RDS Lung function tests - spirometry, bronchoconstriction and bronchodilation tests, blood gases, transfer factor, expired nitric oxide
ENDOCRINOLOGY Disturbances of hormonal regulations – hypothalamic-pituitary axis (primary, secondary and tertiary disorders), feedback loop, causes of hypo- and hyperfunction Disorders of adenohypophysis – regulatory hormones, growth hormone, prolactin, panhypopituitarism Cushing’s syndrome – causes (ACTH dependent, independent, iatrogenic), consequences of increased glucocorticoid levels (obesity, muscle atrophy, diabetes, hypertension, immunosuppression, striae, osteoporosis, CNS) Addison’s disease, disorders of mineralocorticoids – causes and consequences of increased mineralocorticoid levels, hypocorticalism, Addisonian crisis Disorders of adrenal medulla, stress – causes and consequences of increased catecholamines levels (vazoconstriction, organ perfusion), stress reaction, pheochromocytoma Hyperfunction of thyroid gland – causes and consequences of increased thyroid hormone levels, Graves-Basedow´s disease, thyreotoxic crisis Hypofunction of thyroid gland – causes (acquired, congenital) and consequences of decreased thyroid hormone levels, Hashimoto’s thyroiditis, myxedematous coma Disorders of sex hormones in ontogenesis – sex determination and development (types – chromosomal, gonadal, genital, hormonal), (pseudo)hermaphroditisim, (pseudo)pubertas praecox Diabetes mellitus, classification and acute complications – types, prediabetes, insulin deficiency x resistance, symptoms of DM, coma hypoglycemic, ketoacidotic and hyperosmolar (principles of therapy) Chronic complications of diabetes mellitus – macrovascular, microvascular – nephropathy, retinopathy, neuropathy, diabetic foot syndrome, principles of therapy of DM Examination of endocrine glands – adrenal glands (24 hour measurement, dexamethasone suppression test, ACTH production), thyroid gland (TSH/T3/T4, antibodies), DM – glycemia, oGTT, C-peptide, glycated hemoglobin
GIT, METABOLISM Obesity – primary and secondary, types of obesity and adipose tissue (endocrine function), consequences and risks of obesity Metabolic syndrome, gout – diagnostic criteria and other disorders in metabolic syndrome, inzulin resistance, hyperuricemia – causes and clinical manifestations Primary hyponutrition – kwashiorkor, marasmus, simple and stress starvation, cachexia, disorders of food intake (anorexia, bulimia), consequences of malnutrition Malabsorption syndrome – primary (coeliac disease, selective malapsorption) and secondary, consequences of malabsorption Consequences of vitamin deficiency, hypervitaminosis – vitamin A (retina, keratinization), D (Ca/P metabolism), E, K (blood clotting), B1 (beri-beri), folic acid and B12 (anemia, CNS), C (scurvy) Disorders of oesophagus and stomach – motility disorders, GERD, early and late dumping syndrome, pathogenesis of ulcers, functional consequences of gastritis Vomiting, diarrhea – causes (pathogenesis), consequences (changes in hydration, ions, AB balance), complications Constipation, ileus – causes (pathogenesis), consequences (changes in hydration), types of ileus and life threatening complications Pancreatitis – acute and chronic, pathogenesis, diagnostics, consequences and complications (shock, DIC, ARDS), principles of therapy Liver failure – acute and chronic, causes, diagnostics and consequences (encephalopathy, coagulopathy, hepotorenal and hepatopulmonary syndrome) Portal hypertension and ascites – pathogenesis, portocaval shunts, splenomegaly, hypoalbuminemia, hyperaldosteronism, complications Examination of function of liver and pancreas – liver tests, albumin, INR, ammonia, amylase, lipase
NERVOUS SYSTEM Upper motor neuron disorders (spastic paralysis) – causes (corticospinal tract lesions, motoric cortex, decortication and decerebration), paresis/plegia, spasticity, abnormal reflexes (Babinski) Lower motor neuron disorders (flacid paralysis) – causes (radikulopathies, neuropathies), paresis/plegia, atrophy, hyporeflexia, fasciculations and fibrilations Spinal shock – pseudoflacid plegia, phases of development, organ consequences (urinary bladder), neurogenic shock, autonomic dysreflexia Disorders of neuromuscular junction and muscles – motor unit, toxins, myastenia, Lambert-Eaton, muscular dystrophies, myotony, endocrine myopathies Disorders of somatosensoric sensation, pain – dissociation of sensation, spinal syndromes - anterolateral and medial lemniscal system, types of pain, mechanisms of nociception, principles of pain therapy Disorders of basal ganglia – pathways (direct and indirect) and mediators of BG, hypokinetic-hypertonic syndrome (parkinsonism), hyperkinetic-hypotonic syndrome (chorea, athetosis, hemibalism) Cerebellar disorders – paleocerebellar (ataxia, titubation) and neocerebellar syndrome (dyssynergia, dysmetria, adiadochokinesis) Schizofrenia, mood disorders – neurotransmiters, positive (hallucinations, delusions) and negative signs, unipolar and bipolar disorder, anxiety Syndrome of dementia - cognitiv functions, degenerative, vascular, Alzheimer´s disease, frontotemporal dementia, Lewyho bodies dementia Disorders of cerebral blood flow – flow regulation, global disorders and strokes, ischemic (TIA, RIND) and hemorhagic strokes, hypoxic-ischemic encephalopathy), excitotoxicity, penumbra, consequences (motor functions, aphasia etc.), princples of therapy Intracranial hypertension and hypotension – Monro-Kellie doctrine, causes, symptoms (trias), consequences (herniations), princples of therapy Brain edema, disorders of brain blood barier– types (vasogenic, cytotoxic, osmotic, interstitial), brain blood barier - permeability, ontogenetic development(newborns) Sleep disorders and disorders of consciousness – disorders of REM and nonREM phases (insomnia, narcolepsy, somnambulism, sleep paralysis, pavor nocturnus, sleep apnoa), causes of disorders of conciousness (ARAS), quantitative and qualitative disorders (GCS) Epilepsy and epileptic seizures – causes (neurotransmiters, paroxysmal depolarization shift), focal (with elementar or complete symptomatology), generalized (with motoric or without motoric symptoms), status epilepticus Examination method in neurology – EMG, EEG, polysomnography, monosynaptic reflex
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