Pathological Physiology

Syllabus

SYLABUS OF PATHOLOGICAL PHYSIOLOGY modified, valid from 2023/2024

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, ascites – Starling forces, generalized (heart failure, hypoproteinemia) versus localized (inflammatory, venostatic, lymphostatic), pathogenesis of ascites

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, consequences - pathophysiological mechanisms of hypoxic, ischemic, anemic, histotoxic hypoxia, clinical signs, compensatory mechanisms, HIF

Ischemia, ischemia-reperfusion injury, oxidative stress – role in pathogenesis opf disese, consequences on cellular level, ROS, NOS, antioxidants

Chemical and toxic injury of organism – CO, cyanide, nitrates, organophosphates, botulism, alcohol, methanol, paracetamol, amanitin, faloidin, salicylates, digitalis, atropine

Inflammation, SIRS, sepsis - primary and secondary trauma, general mechanisms of cellular damage, factors affecting the susceptibility of specific cells/tissues/organisms to various forms of damage, mechanisms of acute inflammation, chronic inflammation, SIRS/sepsis - definition, pathophysiological mechanisms, clinical signs

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 insufficiency, liver, tumors)

Anemias caused by impaired hematopoesis – bone marrow disorders, erythropoetin, 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, morphologic classification of anemia, percentages of the types of WBCs, erythrocyte sedimentation rate, tests of hemostasis (Quick, aPTT)

CIRCULATION

Pathophysiology of arteries, atherosclerosis – narrowing and obstruction, aneurysms, atherosclerosis (pathogenesis, symptoms)

Pathophysiology of capillaries and veins, vein thrombosis – edemas, specific features of venous flow, thrombosis (deep venous thrombosis, thrombophlebitis), chronic venous insufficiency, varices, embolism

Primary arterial hypertension – mechanisms of BP regulation, BP values, decreased compliance of large arteries, causes (CO, kidneys, sympathetic , 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 coronary syndrome – 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 perfusion scintigraphy, ergometry (ischemia, anaerobic treshold)

Characteristics of pathological ECG recordings - myocardial hypertrophy, ischemic changes, ions imbalance - K+ and Ca2+

RENAL DISEASES

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 – pathogenetic 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, vesicoureteral reflux, urolithiasis

Dialysis: principles and effect – hemodialysis and peritoneal dialysis, principles, indications, advantages and disadvantages

Testing of renal function – urinalysis (casts, protein, hematuria, 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), consequences of 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, isoventilatory 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 controlled, 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 admicture, alveolar death space)

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 (precapillary, postcapillary, 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 asthmaticus), 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 and consequences of restriction (mechanics of breathing, pulmonary hypertension), pathophysiology of ARDS a RDS

Lung function tests - spirometry, bronchoconstriction and bronchodilation tests, blood gases, transfer factor, expired nitric oxide

ENDOCRINOLOGY

Disturbances of hormonal regulations – hypoth

Annotation

Jde o povinný studijní předmět, který patří mezi základní teoretické předměty profilujícího základu. Jeho absolvováním student získá znalosti a dovednosti v oblasti patofyziologie, které jsou nezbytným předpokladem pro další úspěšné studium ve vyšších ročnících. V rámci předmětu student například následující znalosti, dovednosti a kompetence:

- je schopen objasnit funkce a regulační mechanismy lidského organizmu, orgánů a jejich částí ve zdraví, se zřetelem k pochopení základů dysfunkcí v nemoci. Seznámení se základními rysy patologických procesů a jejich možný vznik z fyziologického základu.

- popsat struktury lidského těla a především mechanismy, které se podílí na řízení jeho funkcí, od úrovně molekulární až po orgánovou. Uplatnit poznatky základních vědních lékařských oborů ve své klinické rozvaze a v indikaci vhodných zákroků a vyšetření.