Contents

1. Fundamentals - S. Silbernagl and F. Lang 2
Cell Growth and Cell Adaptation … 2
Abnormalities of Intracellular Signal Transmission … 6
Necrotic Cell Death … 10
Apoptotic Cell Death … 12
Development of Tumor Cells … 14
Effects of Tumors … 16
Aging and Life Expectancy … 18

2. Temperature, Energy - S. Silbernagl 20
Fever … 20
Hyperthermia, Heat Injuries … 22
Hypothermia, Cold Injury … 24
Obesity, Eating Disorders … 26

3. Blood - S. Silbernagl 28
Overview … 28
Erythrocytes … 30
Erythropoiesis, Anemia … 30
Erythrocyte Turnover: Abnormalities, Compensation, and Diagnosis … 32
Megaloblastic Anemia Due to Abnormalities in DNA Synthesis … 34
Anemias Due to Disorders of Hemoglobin Synthesis … 36
Iron Deficiency Anemias … 38
Hemolytic Anemias … 40
Immune Defense … 42
Inflammation … 48
Hypersensitivity Reactions (Allergies) … 52
Autoimmune Diseases … 56
Immune Defects … 58
Hemostasis and its Disorders … 60

4. Respiration, Acid–Base Balance - F. Lang 66
Overview … 66
Ventilation, Perfusion … 68
Diffusion Abnormalities … 70
Distribution Abnormalities … 72
Restrictive Lung Disease … 74
Obstructive Lung Disease … 76
Pulmonary Emphysema … 78
Pulmonary Edema … 80
Pathophysiology of Breathing Regulation … 82
Hypoxia and Hyperoxia … 84
Development of Alkalosis … 86
Development of Acidosis … 88
Effects of Acidosis and Alkalosis … 90

5. Kidney, Salt andWater Balance - F. Lang 92
Overview … 92
Abnormalities of Renal Excretion … 94
Pathophysiology of Renal Transport Processes … 96
Abnormalities of Urinary Concentration … 100
Abnormalities of Glomerular Function … 102
Disorders of Glomerular Permselectivity, Nephrotic Syndrome … 104
Interstitial Nephritis … 106
Acute Renal Failure … 108
Chronic Renal Failure … 110
Renal Hypertension … 114
Kidney Disease in Pregnancy … 116
Hepatorenal Syndrome … 118
Urolithiasis … 120
Disorders ofWater and Salt Balance … 122
Abnormalities of Potassium Balance … 124
Abnormalities of Magnesium Balance … 126
Abnormalities of Calcium Balance … 128
Abnormalities of Phosphate Balance … 130
Pathophysiology of Bone … 132

6. Stomach, Intestines, Liver - S. Silbernagl 134
Function of the Gastrointestinal Tract … 134
Esophagus … 136
Nausea and Vomiting … 140
Gastritis … 142
Ulcer … 144
Disorders After Stomach Surgery … 148
Diarrhea … 150
Maldigestion and Malabsorption … 152
Constipation and (Pseudo-)Obstruction … 156
Acute Pancreatitis … 158
Chronic Pancreatitis … 160
Cystic Fibrosis … 162
Gallstone Disease (Cholelithiasis) … 164
Jaundice (Icterus) … 168
Cholestasis … 168
Portal Hypertension … 170
Fibrosis and Cirrhosis of the Liver … 172
Liver Failure … 174

7. Heart and Circulation - S. Silbernagl 176
Overview … 176
Phases of Cardiac Action (Cardiac Cycle) … 178
Origin and Spread of Excitation in the Heart … 180
The Electrocardiogram (ECG) … 184
Abnormalities of Cardiac Rhythm … 186
Mitral Stenosis … 194
Mitral Regurgitation … 196
Aortic Stenosis … 198
Aortic Regurgitation … 200
Defects of the Tricuspid and Pulmonary Valves … 202
Circulatory Shunts … 202
Arterial Blood Pressure and its Measurement … 206
Hypertension … 208
Pulmonary Hypertension … 214
Coronary Circulation … 216
Coronary Heart Disease … 218
Myocardial Infarction … 220
Heart Failure … 224
Pericardial Diseases … 228
Circulatory Shock … 230
Edemas … 234
Atherosclerosis … 236
Nonatherosclerotic Peripheral Vascular Diseases … 240
Venous Disease … 240

8. Metabolism - S. Silbernagl 242
Overview … 242
Amino Acids … 242
Carbohydrates … 244
Lipidoses … 244
Abnormalities of Lipoprotein Metabolism … 246
Gout … 250
Hemochromatosis … 252
Wilson’s Disease … 252
Heme Synthesis, Porphyrias … 254

9. Hormones - F. Lang 256
General Pathophysiology of Hormones … 256
Abnormalities of Endocrinal Regulatory Circuit … 258
The Antidiuretic Hormone … 260
Prolactin … 260
Somatotropin … 262
Adrenocortical Hormones: Enzyme Defects in Formation … 264
Adrenocorticoid Hormones: Causes of Abnormal Release … 266
Excess Adrenocorticoid Hormones: Cushing’s Disease … 268
Deficiency of Adrenocorticoid Hormones: Addison’s Disease … 270
Causes and Effects of Androgen Excess and Deficiency … 272
Release of Female Sex Hormones … 274
Effects of Female Sex Hormones … 276
Intersexuality … 278
Causes of Hypothyroidism, Hyperthyroidism and Goitre … 280
Effects and Symptoms of Hyperthyroidism … 282
Effects and Symptoms of Hypothyroidism … 284
Causes of Diabetes Mellitus … 286
Acute Effects of Insulin Deficiency (Diabetes Mellitus) … 288
Late Complications of Prolonged Hyperglycemia (Diabetes Mellitus) … 290
Hyperinsulinism, Hypoglycemia … 292
Histamine, Bradykinin, and Serotonin … 294
Eicosanoids … 296

10. Neuromuscular and Sensory Systems - F. Lang 298
Overview … 298
Pathophysiology of Nerve Cells … 300
Demyelination … 302
Disorders of Neuromuscular Transmission … 304
Diseases of the Motor Unit and Muscles … 306
Diagnosis of Motor Unit Diseases … 308
Lesions of the Descending Motor Tracts … 310
Diseases of the Basal Ganglia … 312
Lesions of the Cerebellum … 316
Abnormalities of the Sensory System … 318
Pain … 320
Diseases of the Optical Apparatus of the Eye … 322
Diseases of the Retina … 324
Visual Pathway and Processing of Visual Information … 326
Hearing Impairment … 328
Disorders of the Autonomic Nervous System … 332
Lesions of the Hypothalamus … 334
The Electroencephalogram (EEG) … 336
Epilepsy … 338
Sleep Disorders … 340
Consciousness … 342
Aphasias … 344
Disorders of Memory … 346
Alzheimer’s Disease … 348
Depression … 350
Schizophrenia … 352
Dependence, Addiction … 354
Cerebrospinal Fluid, Blood-Brain Barrier … 356
Cerebrospinal Fluid Pressure, Cerebral Edema … 358
Disorders of Cerebral Blood Flow, Stroke … 360

Literature 362

Index 365