病理生理学（留学生与双语教学用）（英文原版改编版） Pathophysiology

《病理生理学》将中文教材和英文图书《 Pathophysiology  》进行结合调整，章节内容、顺序基本与中文教材一致，系统完善地介绍了病理生理学的基本理论，适用于留学生本科教学。在内容上除沿用了部分病理生理学传统内容外，还增加了一些*前沿的基础医学研究，并引用很多新的临床实例，与临床医学的衔接也更加紧密，使病理生理学真正成为沟通基础医学与临床医学的桥梁。 

《病理生理学》是一门研究疾病发生、发展和转归规律的基础医学学科。它既是一门医学基础学科，也是一门医学交叉学科。由于它是运用生理学、生物化学、微生物学、免疫学等基础学科的相关知识解释疾病发生机制，所以被称为沟通基础医学与临床医学的桥梁。

徐哲龙教授于1998年获得日本山形大学医学博士学位，1999年进入美国南阿拉巴马大学进行博士后研究，2001年以研究员身份就职于美国北卡罗来纳大学麻醉系，2006年升至助理教授，2011年被聘为“天津市特聘教授”及“‘211工程’特聘教授”，2012年被任命为“天津医科大学基础医学院生理学与病理生理学系系主任”。主要研究方向为缺血心脏的保护机制，先后主持多项美国国立卫生研究院（NIH）基金课题及国家自然基金课题，以第一作者或第一通讯作者发表SCI论文30余篇，被引用700多次，并在多个高水平杂志担任编委，如： Basic Research in Cardiology (IF 7.4)及Managing Editor for Frontiers in Bioscience (IF 3.7)。

Contents
目.录
Chapter 1 Altered Cellular and Tissue Biology…………………………………………………………………………… 1 Cellular Injury ………………………………………………………………………………………………………… 1 Cellular Death ……………………………………………………………………………………………………… 10 agIng anD altereD Cellular anD tIssue BIology …………………………………………………… 11 somatIC Death ……………………………………………………………………………………………………… 12
Chapter 2 Fluids and Electrolytes, Acids and Bases ………………………………………………………………… 13 DIstrIButIon of BoDy fluIDs anD eleCtrolytes ………………………………………………………… 13 alteratIons In Water movement …………………………………………………………………………… 15 soDIum, ChlorIDe, anD Water BalanCe …………………………………………………………………… 16 alteratIons In soDIum, ChlorIDe, anD Water BalanCe …………………………………………… 18 alteratIons In PotassIum anD other eleCtrolytes ………………………………………………… 21 aCID-Base BalanCe ………………………………………………………………………………………………… 27 aCID-Base ImBalanCes……………………………………………………………………………………………… 30
Chapter 3 Stress and Disease ……………………………………………………………………………………………… 33 hIstorICal BaCkgrounD anD general ConCePts ……………………………………………………… 33 the stress resPonse ………………………………………………………………………………………………… 37 stress, PersonalIty, CoPIng, anD Illness ………………………………………………………………… 46
Chapter 4 Biology of Cancer ……………………………………………………………………………………………… 50 CanCer termInology anD CharaCterIstICs……………………………………………………………… 50 the BIology of CanCer Cells …………………………………………………………………………………… 51 ClInICal manIfestatIons of CanCer ………………………………………………………………………… 61 DIagnosIs, CharaCterIzatIon, anD treatment of CanCer………………………………………… 63
Chapter 5 Cancer Epidemiology ………………………………………………………………………………………… 67 genetICs, ePIgenetICs, anD tIssue …………………………………………………………………………… 68 In utero anD early lIfe ConDItIons ………………………………………………………………………… 68 envIronmental-lIfestyle faCtors ………………………………………………………………………… 68
Chapter 6 Pain, Temperature and Sleep ………………………………………………………………………………… 80 PaIn ……………………………………………………………………………………………………………………… 80 temPerature regulatIon………………………………………………………………………………………… 86 sleeP ……………………………………………………………………………………………………………………… 90
Chapter 7 Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function ……………… 92
alteratIons In CognItIve systems …………………………………………………………………………… 92
alteratIons In CereBral hemoDynamICs ………………………………………………………………… 106

alteratIons In neuromotor funCtIon …………………………………………………………………… 109
Chapter 8 Disorders of the Central and Peripheral Nervous Systems and Neuromuscular Junction ……… 113 Central nervous system DIsorDers ………………………………………………………………………… 113 PerIPheral nervous system anD neuromusCular junCtIon DIsorDers ……………………… 131
Chapter 9 Alterations of Hormonal Regulation ……………………………………………………………………… 133 meChanIsms of hormonal alteratIons…………………………………………………………………… 133 alteratIons of the hyPothalamIC-PItuItary system ……………………………………………… 134 alteratIons of thyroID funCtIon …………………………………………………………………………… 139 alteratIons of ParathyroID funCtIon …………………………………………………………………… 143 DysfunCtIon of the enDoCrIne PanCreas: DIaBetes mellItus …………………………………… 144 alteratIons of aDrenal funCtIon ………………………………………………………………………… 154 tumors of the aDrenal meDulla …………………………………………………………………………… 157
Chapter 10 Structure and Function of the Hematologic System …………………………………………………… 159 ComPonents of the hematologIC system ………………………………………………………………… 159 meChanIsms of hemostasIs ……………………………………………………………………………………… 165 antICoagulant system …………………………………………………………………………………………… 169
Chapter 11 Alterations of Hematologic Function……………………………………………………………………… 171 alteratIons of erythroCyte funCtIon …………………………………………………………………… 171 alteratIons of leukoCyte funCtIon ……………………………………………………………………… 179 hemorrhagIC DIsorDers anD alteratIons of Platelets anD CoagulatIon ……………… 185
Chapter 12 Regulation of Cardiovascular Function ………………………………………………………………… 194 the CIrCulatory system ………………………………………………………………………………………… 194 the systemIC CIrCulatIon ……………………………………………………………………………………… 197
Chapter 13 Alterations of Cardiovascular Function ………………………………………………………………… 205 DIseases of the arterIes ………………………………………………………………………………………… 205 manIfestatIons of heart DIsease …………………………………………………………………………… 225 shoCk …………………………………………………………………………………………………………………… 230

Chapter 14 Function of the Pulmonary System ……………………………………………………………………… 241
funCtIon of the Pulmonary system ………………………………………………………………………… 241
Chapter 15 Alterations of Pulmonary Function ……………………………………………………………………… 251 ClInICal manIfestatIons of Pulmonary alteratIons ……………………………………………… 251 Pulmonary DIsorDers …………………………………………………………………………………………… 258
Chapter 16 Function of the Renal and Urologic Systems …………………………………………………………… 280 regulatIon of renal BlooD floW …………………………………………………………………………… 280 kIDney funCtIon …………………………………………………………………………………………………… 281 tests of renal funCtIon ………………………………………………………………………………………… 285
Chapter 17 Alterations of Renal and Urinary Tract Function ……………………………………………………… 288 urInary traCt oBstruCtIon …………………………………………………………………………………… 288 urInary traCt InfeCtIon ………………………………………………………………………………………… 295 glomerular DIsorDers …………………………………………………………………………………………… 298 aCute kIDney Injury ……………………………………………………………………………………………… 301 ChronIC kIDney DIsease…………………………………………………………………………………………… 305

Chapter 18 Alterations of the Female Reproductive System ……………………………………………………… 311 Chapter 19 Alterations of Digestive Function ………………………………………………………………………… 331
DIsorDers of the gastroIntestInal traCt ……………………………………………………………… 331 DIsorDers of the aCCessory organs of DIgestIon …………………………………………………… 347 CanCer of the DIgestIve system ……………………………………………………………………………… 358
Chapter 20 Alterations of Musculoskeletal Function ………………………………………………………………… 362 musCuloskeletal InjurIes ……………………………………………………………………………………… 362 DIsorDers of Bones ………………………………………………………………………………………………… 371 DIsorDers of joInts ………………………………………………………………………………………………… 380 DIsorDers of skeletal musCle ………………………………………………………………………………… 394 musCuloskeletal tumors ……………………………………………………………………………………… 402

Preface
前.言
Pathophysiology is an essential course for medical students to understand the functional changes in cells, tissues, and organs resulting from disease or injury. Understanding of pathophysiology is necessary for medical students to study clinical courses and practices. At Tsinghua University Press’s request, we adapted the pathophysiology original textbook termed “UNDERSTANDING PATHOPHYSIOLOGY” for foreign students who study medical courses in English in China. Edited by Sue E. Huether and Kathryn
L. McCance, UNDERSTANDING PATHOPHYSIOLOGY is a great textbook and organized into two parts:
Basic Concepts of Pathophysiology, Body Systems and Disease. The first part consists of 3 units, and the
second part includes 9 units. Each unit is presented in the order of the normal structure and function, pathophysiological alterations including symptoms and mechanisms, and alterations in children.
This time we recomposed the book in accordance with the syllabuses of pathophysiology in medical schools in China resulting in eliminations of some parts of contents in the original book. We placed more emphasis on describing the pathophysiological alterations and the underlying mechanisms, but eliminated the most parts of anatomy and alterations in children. In addition, this book also deleted figures and references with the eliminations of the related contents. Throughout the recomposition process, we made every effort to avoid mispresentations of the original work by paying great respect for the original authors.
This book is designed mainly for foreign medical students who study in medical schools in China. The book emphasizes general pathophysiological concepts and mechanisms of various diseases using the most recent information. We hope that students find this book useful for understanding of pathophysiology and for their future practice. I hope that students will provide constructive comments to improve future editions of this book.
I am grateful to my co-author colleagues selected from well-known universities for their knowledge and tremendous labor of revising chapters to make them highly readable for students and teachers. I have to express my special thanks to Dr. Di Hongjun and Qin Jiangyu who made great contributions to this project. I also wish to my appreciation to Li Jun from Tsinghua University Press-we have had a great collaboration throughout the planning and execution of this project!
XU Zhelong, MD, PhD
Department of Physiology & Pathophysiology Tianjin Medical University