Pathophysiology 2

Data

Official data in SubjectManager for the following academic year: 2022-2023

Topic

Pathophysiology 2 deals with the etiology, time-course and clinical symptoms, as well as with possible pharmacological and other interventions in disorders of the gastrointestinal system, energy balance, intermediary metabolism and endocrine systems.

Lectures

• 1. Basic concepts of gerontology - Dr. Balaskó Márta
• 2. Swallowing and esophageal disorders - Dr. Hegyi Eszter
• 3. Disorders of gastric filling and emptying. Vomiting - Dr. Hegyi Eszter
• 4. Ulcer disease - Dr. Hegyi Eszter
• 5. Dysmotilities. Ileus - Dr. Hegyi Eszter
• 6. Maldigestion, malabsorption. Diarrhea - Dr. Hegyi Eszter
• 7. Forms of pancreatitis - Dr. Hegyi Eszter
• 8. Liver: metabolic functions and detoxication. Jaundice - Dr. Hegyi Eszter
• 9. Portal hypertension, ascites, cirrhosis - Dr. Hegyi Eszter
• 10. Hepatic coma - Dr. Hegyi Eszter
• 11. Factors and changes of energy balance. Body mass - Dr. Balaskó Márta
• 12. Full starvation - Dr. Balaskó Márta
• 13. Partial starvation - Dr. Balaskó Márta
• 14. Negative energy balance, sarcopenia. Abnormalities of body composition - Dr. Balaskó Márta
• 15. Obesity - Dr. Balaskó Márta
• 16. Cardiorespiratory adaptation to work I - Dr. Balaskó Márta
• 17. Cardiorespiratory adaptation to work II - Dr. Balaskó Márta
• 18. Cardiorespiratory adaptation to work III - Dr. Balaskó Márta
• 19. Disorders of cold defense - Dr. Garami András
• 20. Disorders of warm defense - Dr. Garami András
• 21. Fever and sickness behavior - Dr. Garami András
• 22. Pathophysiology of carbohydrate metabolism and insulin effects. - Dr. Balaskó Márta
• 23. Diabetes mellitus (DM) syndrome - Dr. Balaskó Márta
• 24. Type-1 DM: etiology, pathogenesis, pathomechanism - Dr. Balaskó Márta
• 25. Type-2 DM: etiology, pathogenesis, pathomechanism - Dr. Balaskó Márta
• 26. Acute complications of DM, diabetic coma - Dr. Balaskó Márta
• 27. Late complications of DM - Dr. Balaskó Márta
• 28. Hypoglycemia - Dr. Balaskó Márta
• 29. Disorders of protein and amino acid and nucleic acid metabolism - Burzánné Dr. Pétervári Erika
• 30. Pathophysiology of alcohol effects. Liver toxins. Cirrhosis. - Dr. Balaskó Márta
• 31. Disorders of lipid metabolism - Dr. Garai János
• 32. Dyslipidemias - Dr. Garai János
• 33. Atherosclerosis - Dr. Garai János
• 34. Disorders of the hypothalamo-pituitary system - Dr. Garai János
• 35. Hyperprolactinemia. Disorders of growth - Dr. Garai János
• 36. Thyroid hyperfunctions - Dr. Garai János
• 37. Thyroid hypofunctions - Dr. Garai János
• 38. Disorders of the adrenal medulla. M.E.N. - Dr. Garai János
• 39. Hypofunction of the adrenal cortex - Dr. Garai János
• 40. Hyperfunction of the adrenal cortex. Glucocorticoid treatment - Dr. Garai János
• 41. Disorders of the gonadal hormones. Adrenogenital syndrome - Dr. Garai János
• 42. Disorders of the pathyroid gland, Ca and bone - Dr. Garai János

Practices

• 1. Age-related specificities of salt/water balance
• 2. Age-related specificities of acid/base balance
• 3. Recommendations in human nutrition
• 4. Diet. Enteral and parenteral nutrition
• 5. Macro- and micronutrients
• 6. Vitamins
• 7. Case reports (ethylene glycol- or mushroom-intoxication)
• 8. Case reports (septic shock, traumatic shock)
• 9. Case reports (acute stress ulcer)
• 10. Case reports (pericarditis, anemia)
• 11. Case reports (pathological changes in pregnancy)
• 12. Case reports (cirrhosis)
• 13. Case reports (pancreatitis)
• 14. Spiroergometry demonstration I
• 15. Spiroergometry demonstration II
• 16. Physical activity, inactivity. Factors connected with lifestyle/age
• 17. Immobilisation syndrome
• 18. Disorders of consciousness, coma
• 19. Acute loss of consciousness
• 20. Case reports (type-1 diabetic coma)
• 21. Case reports (type-2 diabetic coma)
• 22. Case reports (late complications of DM, aspects of therapy in DM)
• 23. Case reports (hypoglycemic coma)
• 24. Case reports (heat stroke)
• 25. Complex analysis of energy balance
• 26. Case reports (Addisons's disease, Conn's syndrome, atrial fibrillation)
• 27. Case reports (complications of osteoporosis)
• 28. Case reports (hyperthyroidism in the elderly)

Seminars

Reading material

Obligatory literature

M. Székely (ed.): Basic Concepts in Pathophysiology, Medicina Publishing House, Budapest, 2019

Literature developed by the Department

Koller Á.: 606 minimum-questions, PTE ÁOK, 2010
M. Székely (ed.): Basic Concepts in Pathophysiology, ÁOK PTE, 2007
Lecture slides will also be uploaded to TEAMS.

Notes

M. Székely (ed.): Basic Concepts in Pathophysiology, ÁOK PTE, 2007

Recommended literature

S. Silbernagl, F. Lang : Color Atlas of Pathophysiology, Thieme Stuttgart - New York, 2000
Harrison: The Principles of Internal Medicine, 18th edition, (respective chapters), McGraw-Hill 2015

Conditions for acceptance of the semester

Maximum of 15 % absence allowed

Mid-term exams

A compulsory multiple choice midterm test is organized during the second half of the second semester. In case of absence or lower than 34% score, a 4th exam question is added to the final exam. The Midterm Test can not be retaken.

Making up for missed classes

Students can make up for their absence by participating at the seminar of another group on the same week. Students may be absent from 2 seminars (4 times 45 minutes).

Exam topics/questions

Questions for THE final exam:

FROM FIRST SEMESTER

Cardiovascular adaptation in health and disease.
Distribution of cardiac output and its disorders in the young and the elderly.
Causes and forms of heart failure.
Forward failure symptoms (left- and right-sided) in heart failure.
Backward failure symptoms (left- and right-sided) in heart failure.
High output cardiac failure.
Vasovagal syncope.
Definition and classification of circulatory shock. Pathophysiology of development, phases and characteristics of microcirculation.
Hypovolemic shock: causes and hemodynamics.
Cardiogenic shock: causes and hemodynamics.
Distributive shock: causes and hemodynamics.
Organ manifestations of shock.
Tissue hypoxia, ischemia, reperfusion and tissue metabolism.
Pathogenesis of coronary insufficiency. Risk factors.
Pathomechanism and consequences of acute myocardial infarction.
Cerebral hypoxia, ischemia, stroke.
Pulmonary circulation, pulmonary hypertension.
General pathophysiology and classification of systemic hypertension - age and blood pressure.
Role of the kidneys in the development of hypertension. Effects of hypertension on the kidneys.
Hypertension and the adrenal gland.
Primary hypertension: characteristics and etiological factors.
Consequences of hypertension.
Orthostatic hypotension in the young and the elderly.
Active heterotopic abnormalities (premature beats).
Passive heterotopy: causes, forms and consequences.
Supraventricular and a-v junctional blocks.
Forms and importance of intraventricular conduction abnormalities.
Pre-excitation syndromes.
Forms and consequences of paroxysmal tachycardia.
Signs of chronic or acute overload in the ECG (hypertrophy, strain).
Primary and secondary repolarization abnormalities in the ECG.
ECG in acute myocardial infarction.
Atrial or ventricular flutter, atrial or ventricular fibrillation.
Principles/evaluation of respiratory function tests. Characteristics and parameters of abnormal breathing mechanics.
Disorders of the control of breathing. Age-dependent changes. Sleep-apnea syndrome.
The work of breathing. Abnormalities of elastic resistance, restrictive disorders.
Alveolar hypoventilation: causes and consequences.
Acute and chronic alveolar hyperventilation.
Ventilation-perfusion mismatch (V/Q): causes and consequences.
Disorders of alveolo-capillary diffusion. Hepatopulmonary syndrome.
Forms and mechanisms of hypoxia. Ways of compensation - cyanosis. CO-poisoning, methemoglobinemia.
Causes and consequences of increased airway resistance - causes and consequences of chronic obstructive pulmonary disease (COPD) - emphysema.
Partial or complete respiratory failure.
Dyspnea.
Forms, general pathophysiology and consequences of anemia.
Aplastic anemia and anemias of complex etiology in disease states.
Deficiency anemias.
Hemolytic anemias.
Polycythemias, polyglobulias.
Bleeding abnormalities due to platelet or vascular factors.
Congenital and acquired coagulopathies.
Thrombosis: causes and consequences.
Disseminated intravascular coagulation (DIC).
Granulocytes in inflammatory processes.
Pathophysiology of glomerular filtration.
Disorders of tubular functions.
Proteinuria.
Hyposthenuria, asthenuria, osmotic diuresis.
Chronic renal failure: causes, characteristics and progression.
Metabolic disorders and organ dysfunctions in uremia.
Uremic coma.
Acute renal failure: occurrence, general features - extrarenal uremia. Prerenal azotemia. Postrenal failure.
Acute tubular nephropathy.
Acute diffuse glomerulonephritis.
Compensation of pH-abnormalities (plasma and intracellular puffers, respiration, kidney) and their disturbances.
Metabolic acidosis: causes, compensation, consequences.
Metabolic alkalosis: causes, compensation, consequences.
Respiratory acidosis and alkalosis: causes, compensation, consequences.
Disorders of potassium balance. Hypo- and hyperkalemia.
States of decreased extracellular volume, and their consequences.
States of elevated extracellular volume: causes, mechanisms and consequences.
Hyperosmolarity, hypertonicity. Forms, causes, consequences.
Hypotonicity: pathogenesis and consequences.
Tissue injury, inflammation, lymphatic circulation.
Definitions and causes of sepsis and trauma.


FROM SECOND SEMESTER
Disorders of chewing, swallowing and esophagus functions - the gastro-esophageal reflux disease.
Disorders of gastric filling and emptying.
Vomiting (acute, chronic).
Peptic ulcer. Stress-ulcer in the elderly.
Specific malabsorption syndromes (level of the disorder /gastric, pancreatic, hepato-biliary/ or substrate of disorder).
Complex malabsorption syndromes.
Diarrhea: causes, pathophysiological forms, consequences.
Bowel obstruction (ileus).
Obstipation, subileus, diverticulosis. GIT motility disorders.
Acute pancreatitis: pathophysiology and consequences.
Pathophysiology of chronic pancreatitis.
Disorders of intermediary metabolism in general liver cell damage.
Jaundice.
Cirrhosis: causes, mechanisms and consequences.
Portal hypertension.
Ascites and hepatorenal syndrome.
Hepatic coma.
Pathophysiology of alcohol effects.
Physical activity, inactivity, immobilization syndrome. Factors from lifestyle and age.
Hypo- and hypervitaminosis, micronutrients.
Water-soluble vitamins.
Fat-soluble vitamins.
Complete starvation: occurrence and process.
Partial starvation, accelerated forms of energetic insufficiency - anorexia nervosa. Refeeding.
Protein deficiency. Protein-calorie malnutrition. Senile sarcopenia.
Obesity: criteria, classification and epidemiology.
Etiology and pathogenesis of obesity.
Consequences of obesity. Therapeutic possibilities.
Metabolic syndrome.
Cold-defense and cold-induced disorders.
Warm-defense and heat-induced disorders.
Heat stroke and malignant hyperthermia.
Pathogenesis of fever. Fever and sickness-behavior. The biological value of fever.
Hyperglycemia and glucose-tolerance tests. Diagnosis of diabetes mellitus.
Basic characteristics and forms of diabetes mellitus syndrome.
General pathobiochemistry of diabetes mellitus syndrome.
Etiology and pathogenesis of 1DM.
Etiology and pathogenesis of 2DM.
Diabetic ketoacidosis (DKA) and ketoacidotic coma.
Diabetic hyperosmolar syndrome (HHS) and coma.
Late complications of diabetes mellitus: Diabetic micro- and macro-vascular disorders.
Hypoglycemia.
Hypo- and hyper-proteinemia.
Disturbances of amino acid metabolism.
Gout.
Pathobiochemistry of LDL-metabolism. Primary and secondary hyperlipoproteinemia.
Atherosclerosis: its cellular and molecular pathophysiology.
Disorders of the hypothalamo-pituitary system. Pituitary insufficiency.
Pituitary adenomas, hyperprolactinemia.
Pathophysiology of growth.
Hyperthyroidism. Specialities in the elderly.
Hypothyroidism. Specialities in the elderly.
Goiters.
Disturbances of the adrenal medulla and the sympathetic system - pheochromocytoma.
Adrenogenital syndrome.
Adrenal (cortex) insufficiency.
Primary hyperaldosteronism.
Secondary hyperaldosteronism.
Glucocorticoid hyperfunctional states.
Pathophysiological aspects of glucocorticoid therapy.
Parathyroid abnormalities.
Hypocalcemia, hypercalcemia.
Mechanisms and disturbances of bone remodeling. Osteoporosis, osteomalacia.
Disturbances of consciousness, vigilance. Coma. Acute unconsciousness.
Principles of exercise testing (spiro-ergometry). Anaerobic threshold and maximal oxygen consumption during exercise.
Basic concepts of gerontology.


Oral final exam. Occasionally, assorted questions from the "606 minimum-questions" booklet also have to be answered: from 5 minimum questions students have to give correct answers to 4 at least, to be able to continue the oral exam. The final exam consists of 3 questions (one card) and the analysis of 1 ECG record as well as that of 1 case report. (Similar case-reports are discussed extensively during the course of the second semester.)

Examiners

• Burzánné Dr. Pétervári Erika
• Dr. Balaskó Márta
• Dr. Garai János
• Dr. Garami András
• Dr. Székely Miklós

Instructor / tutor of practices and seminars

• Dr. Balaskó Márta
• Dr. Garai János
• Dr. Garami András
• Dr. Hegyi Eszter
• Dr. Tóth Luca
• Némethné Dr. Tóth Ildikó