PP Chapter 1 -已融合 PDF

Introduction to Human Diseases: Physiology and
Pathophysiology
(Part 1: Endocrine, reproductive, renal, gastrointestinal, neonatal,
and age-related diseases)
Lecturer: Dr. Samuel Ng
E-mail: samuel.ng@hkuspace.hku.hk
http://kids.britannica.com/elementary/art-89496 1
http://on-line.ucol.ac.nz/mt100/Renal.htm
/Men-and-women-have-different-reproductive-organs http://www.emedicinehealth.com/anatomy_of_the_endocrine_system/article_em.htm
Intended learning outcomes
• Discuss the pathology of tissue injury and the process of tissue adaptation
and repair 探讨组织损伤的病理理及组织的适应和修复过程
• Explain the significance of inflammation to the development of human

diseases 解释炎症在⼈人类疾病发展中的重要性
• Discuss the etiology, symptoms, and treatments of common diseases in the

nervous, respiratory, cardiovascular, endocrine, reproductive, renal, and
gastrointestinal systems 讨论神经、呼吸、⼼心⾎血管、内分泌泌、⽣生殖、肾脏和
胃肠道等常⻅见疾病的病因、症状和治疗
• Explain the molecular and cellular mechanisms for various disease

conditions in humans
解释⼈人类各种疾病的分⼦子和细胞机制
• Discuss the pathophysiology of neonatal diseases and age-related diseases

in the elderly
讨论新⽣生⼉儿疾病和老年年⼈人年年龄相关疾病的病理理⽣生理理学
2
下丘腦垂體甲狀狀腺疾病
Chapter 1: Hypothalamus, pituitary, and thyroid disorders
Learning objectives:
• Explain how endocrine disorders arise and
distinguish between primary and secondary
endocrine disorders
解释内分泌泌疾病是如何产⽣生的，并区分原发性和继发性内分泌泌疾病
• Describe different types of disorders in the

hypothalamus-pituitary axis and how they
can be treated
描述不同类型的疾病在下丘脑-垂体轴和如何可以治疗
• Describe different types of thyroid disorders

(i.e. hypothyroidism and hyperthyroidism)
and how they can be treated and diagnosed
描述不同类型的甲状腺疾病(即甲状腺功能减
退和甲状腺功能亢进)，以及如何治疗和诊断
http://thyrovision.net/FAQ 3
http://www.rayur.com/pituitary-mri-definition-prepare-indications-complications-procedure-perform-and-result.html
Endocrine disorders
內分泌泌失調
• Most endocrine disorders belong to one

of the following categories:
激素过少
1. Too little hormone (Hyposecretion) (分泌泌過少)
2. Too much hormone (Hypersecretion) 激素过多
(分泌泌过多)
3. Reduced response of the target cells
(Hyporesponsiveness) 靶细胞反应减少(低反应性)
4. Increased response of the target cells
(Hyperresponsiveness) 靶细胞反应增强(⾼高反应性)
• Imbalance of the endocrine system → The concept of “yin and yang” is

analogous to the delicate balance of
endocrine disorders hormonal activity in our body.
内分泌泌系统失衡→内分泌泌紊乱
4
http://endocrinesurgery.ucla.edu/patient_education_adm_graves_disease.html
Primary vs Secondary endocrine disorders
• Primary: Endocrine gland functions

abnormally, leading to hypo- or hyper-
secretion of hormones
原发: 内分泌泌腺功能异常，导致激素分泌泌过少或过多
• Secondary: Endocrine gland is normal but

there is either too little or too much tropic
hormones
第⼆二: 内分泌泌腺正常，但促內分泌泌激素太少或太多
5
http://endocrinesurgery.ucla.edu/patient_education_adm_primary_secondary_hypothyroidism_illustration.html
Hypo- vs Hyper-responsiveness
• Hypo-responsiveness: Target 去甲腎上腺素腺苷酸环化酶

cells do not respond to the
hormone (e.g. lack of receptors
and defective second
messenger pathways)
低反应性:靶细胞对激素没有反应(如
受体缺失和第⼆二信使通路路缺陷)
• Hyper-responsiveness: Target
cells are too sensitive to certain
hormones ⾼高反应性:靶细胞对某些激素过于敏感
(e.g. Hypersecretion of thyroid
hormones → ↑ receptors for
epinephrine → ↑ heart rate)
腎上線
6
http://droualb.faculty.mjc.edu/Course%20Materials/Physiology%20101/Chapter%20Notes/Fall%202011/chapter_13%20Fall%202011.htm
Hypothalamus-pituitary axis and
its disorders
下丘脑-垂体轴及其紊乱
7
Hypothalamus-pituitary axis
神經元合成垂體後葉
激素
• Hypothalamus and pituitary are 合成營養激素的神

經元將其釋放到⾨門
anatomically and functionally 系統的⾎血漿中
connected
下丘腦和垂體在解剖上和功能上是相連的
⻔门脉直接将营
• Pituitary is known as the master 养激素输送到
垂体前叶。
gland, but hypothalamus is
pituitary’s master
垂體是主線體，⽽而下丘腦是垂體的
主⼈人
• Hypothalamus-pituitary axis is a
neuroendocrine organ 內分泌泌細胞將其激
下丘腦-垂體軸是神經內分泌泌器素釋放到第⼆二組⽑毛
官隽細⾎血管中，以分配
到⾝身體的其他部位
• Pituitary has 2 lobes: Anterior
(glandular) and posterior
(neural)
垂體有2個裂片：前（腺）和後（神
8
經）
http://www.acbrown.com/neuro/Lectures/Hpth/NrHpthOtpt.htm
Anterior pituitary
下丘腦激素釋放到特殊⾎血管（垂體⾨門脈
系統）中控制垂體前葉激素的釋放
• Hypothalamic hormones released into special blood vessels (hypophyseal
portal system) control the release of anterior pituitary hormones
垂體前上動脈
當受到適當刺刺激時，下丘
下丘腦激素通過⾨門靜脈到達垂體腦神經元分泌泌釋放或抑制
前葉釋放的垂體前葉激素激素進入初級⽑毛細⾎血管叢
垂體⾨門脈系統
⾨門靜脈系統是由靜脈連
接的兩兩個⽑毛細⾎血管叢
作為對釋放激素的反應，垂體前葉
將激素分泌泌到秘書⽑毛細⾎血管叢中。
這反過來來⼜又變成了了普通流通。
9
Human Anatomy and Physiology, 9th Ed.
下丘腦神經元（室旁和視上核）產⽣生神經衝動
→神經信號沿軸突（下丘腦下垂體）傳播→催
產素和ADH從垂體後葉軸突伸釋放 Posterior pituitary
• Hypothalamic neurons (paraventricular and supraoptic nuclei) generate nerve
impulses → Nerve signals travel down the axons (hypothalamic hypophyseal
tract) → Oxytocin and ADH release from axon terminals in the posterior pituitary
下丘腦神經元合成催
產素或抗利利尿尿激素
催產素和ADH沿下丘腦-垂體道
的軸突向下運輸⾄至垂體後葉
被储存在垂体后
叶的轴突末端
当相关的下丘脑神经元放电时，
到达轴突末端的动作电位导致催 10
产素或ADH释放到⾎血液中。
Human Anatomy and Physiology, 9th Ed.
Summary of the hormones secreted from
hypothalamus and pituitary
神經內分泌泌細胞
http://pitbeh.info/pituitary-gland-hormones/ 11
http://droualb.faculty.mjc.edu/Course%20Materials/Physiology%20101/Chapter%20Notes/Fall%202011/chapter_6%20Fall%202011.htm
垂体疾病:垂体腺瘤
Pituitary disorder: Pituitary adenomas

脑下垂体的良性肿瘤
• Cause: Benign tumors in the pituitary gland
• Signs and symptoms:

肿瘤增⼤大和出⾎血
- Enlargement of tumors and hemorrhage 腫瘤
→ ↑ pressure in the skull, headaches,

seizures, drowsiness, and visual defects
颅骨压⼒力力、头痛、癫痫、嗜睡和视觉
缺陷
- Tumor cells may secrete excessive hormones
(e.g. GH)
肿瘤细胞可能分泌泌过多的激素(如GH)
- Tumor cells may destroy some or all pituitary

cells 肿瘤细胞可能破坏部分或全部垂体细胞
→ ↓ pituitary hormone secretion 垂体激素分泌泌
→ Hypopituitarism
垂体机能减退
12
http://research.vet.upenn.edu/SystemicPathology/Exam4/CommonLargeAnimalLesi
http://neurosurgery.ucla.edu/body.cfm?id=145 ons/tabid/3648/galleryType/SlideShow/ItemID/420/AlbumID/39/Default.aspx
Pituitary adenomas
Hormone overproduction
(hypersecretion)
Pituitary adenomas
Hormone deficiency
(hyposecretion)
13
Hypothalamus and pituitary disorder:
Dwarfism, gigantism, and acromegaly
• Dwarfism: Deficit of GH or somatotropin-
releasing hormone secretion
侏儒症:⽣生⻓长激素或促⽣生⻓长激素释放激素分泌泌不⾜足
• Gigantism: Excess GH secretion before puberty

巨⼈人症:青春期前GH分泌泌过多
• Acromegaly: Excess GH secretion in adults (after

bone growth stops) 肢端肥⼤大症:成⼈人体内GH分泌泌过多(以后)
骨骼⽣生⻓长停⽌止)
http://news.asiantown.net/r/27885/7feet-2-inches--400lbs-Woman-with-gigantism- 14
http://thoughtcafe.co.uk/5-weird-diseases-you-didnt-know-existed-until-now/
disorder-di--101-s-at-34 http://www.besthealthadvisor.com/different-types-of-dwarfism/
How dwarfism is treated?
• Dwarfism can be treated by

administration of GH
Lionel Messi is a famous footballer

who once suffered from dwarfism.
15
How gigantism or acromegaly is treated?
• Radiotherapy
• Chemotherapy
• Surgery (e.g. endoscopic endonasal

approach)
(https://www.youtube.com/watch?annot
ation_id=annotation_1002742407&featur
e=iv&src_vid=KkvcGXrKmDU&v=aih0kqd1
3Y8) 1. no incisions to heal 無切⼝口可癒合
- Why endoscopic endonasal approach is 2. faster recovery time
3. reduced risk of neurologic damage
better than the traditional brain surgery? 降低神經損傷的風險
4. fewer side effect
- What is the use of the fat pads after the
surgery?
16
http://www.upmc.com/services/neurosurgery/brain/treatments/endoscopic-endonasal-approach/pages/default.aspx
垂體疾病：糖尿尿病
Pituitary disorder: Diabetes insipidus (DI)

DI 是由於CNS(垂体后叶或下丘脑)疾病导致的
抗利利尿尿激素(ADH)缺乏和/或肾脏对ADH⽆无反应
• Cause: DI is due to a lack of anti-diuretic
hormone (ADH) owing to disease of
CNS (posterior pituitary or
hypothalamus) and/or inability of
kidney to respond to ADH
• Signs and symptoms: Polyuria (large

volumes of dilute urine) → Thirst →
Severe dehydration
体征和症状:多尿尿(⼤大量量稀尿尿)→⼝口渴→严重脱⽔水
• Treatment: Replacement therapy for

ADH
治疗:ADH的替代治疗
17
http://medicaltextboks.blogspot.hk/2013/05/textbook-diabetes-insipidus.html
垂体障碍:
不适当ADH综合征(SIADH)
Pituitary disorder: Syndrome of inappropriate ADH

(SIADH)
• Cause: SIADH is due to excess ADH 滲透壓感受器
secretion; can be triggered by stress or

secreted by an ectopic tumor (e.g. lung
cancer) SIADH是由于过量量的ADH分泌泌;可由压
⼒力力引起或由异位肿瘤(例例如肺癌)分泌泌
→ Excessive water retention and Na+
excretion 過多的保⽔水性 + 鈉排洩
• Signs and symptoms: Hyponatremia (low

serum Na+ levels) → Mental confusion
and irritability
体征和症状:低钠⾎血症(低⾎血清钠+⽔水平)→精神混乱和
易易怒
• Treatments: Diuretics (drugs which

enhance urine production) and sodium
supplements
利利尿尿剂(提⾼高尿尿量量的药物)和钠补充剂
http://www.virtualmedicalcentre.com/diseases/syndrome-of- 18
inappropriate-antidiuretic-hormone-secretion-siadh/149
Effects of DI, SIADH, and dehydration on serum Na+,
serum osmolality and urine osmolality
• Based on what you have learned about DI and SIADH, fill in the following
table [Osmolality = concentration of the particles dissolved in a fluid
(expressed in milliosmoles/kg) (mOsm/kg) of solvent]:
Disorder Serum Na+ Serum Urine

Osmolality Osmolality
Diabetes
insipidus
SIADH
Dehydration
19
Thyroid gland and thyroid
disorders
20
Thyroid gland
• Secretes thyroid hormones that
increase metabolic rate
分泌泌甲状腺激素，增加代谢率
• Two iodine-containing
下丘脑增加TRH
hormones: thyroxine (T4; 的分泌泌进入⾎血液
circulating) and triiodothyronine

腺管细胞增加
(T3; active form) TSH的分泌泌进
两种含碘激素:甲状腺素(T4;循环) 入循环
和三碘代甲状腺素(T3;活动形式)
• Secretion is initiated by TRH

from hypothalamus and 甲状腺增加⾎血液
中T3和T4的分泌泌
stimulated by TSH from anterior
pituitary 分泌泌由下丘脑的TRH启动，由脑
垂体前叶的TSH刺刺激
• Negative feedback to pituitary

and hypothalamus with high
levels of T3 and T4 垂体、下丘脑呈负反馈，T3、T4⽔水平⾼高
21
Gould and Dyer. Pathophysiology for the Health Professions. 4th Ed., Saunders Elsevier
甲状腺疾病:甲状腺肿
Thyroid disorder: Goiter
甲状腺肿⼤大
• Goiter = Enlargement of thyroid gland
地⽅方性甲状腺肿影响⽣生活在食物中碘⽔水平低的地
区的⼈人们，因为碘是合成甲状腺激素所必需的
• Endemic goiter affects people living in areas with
low iodine levels in food because iodine is
essential for the synthesis of thyroid hormones
→ ↓ T3 and T4 production (hypothyroidism) 甲状腺功能减退
→ ↑ TSH production from anterior pituitary
→ Thyroid enlargement
• Toxic goiter is associated with an autoimmue

disease 中毒性甲状腺肿与⾃自⾝身免疫性疾病有关
→ Continuous stimulation of TSH receptors
→ ↑ T3 and T4 production (hyperthyroidism) and
thyroid enlargement ↑T3和T4⽣生成量量(甲状腺机能亢进)和
甲状腺肿⼤大
22
http://flipper.diff.org/app/items/info/5440 Gould and Dyer. Pathophysiology for the Health Professions. 4th Ed., Saunders Elsevier
Thyroid disorder: Hyperthyroidism ⽂文字
(Graves’ disease or toxic goiter)
• Hyperthyroidism that leads to increased T3 and T4
secretion (e.g. Graves’ disease); occurs more
frequently in women > 30 years old
甲状腺机能亢进，导致T3、T4分泌泌增加
(如Graves病);多⻅见于30岁以上的女性
• Cause: An autoimmune disorder that attacks the
thyroid gland → ↑ stimulation of TSH receptors by
autoantibody → ↑ release of thyroid hormones
病因:攻击甲状腺的⾃自⾝身免疫性疾病→⾃自⾝身抗
体刺刺激TSH受体↑→甲状腺激素释放↑
• Symptoms:
- ↑ T3 and T4 in blood → Hypermetabolism 代谢亢进
- Protruding eyes (exophthalmos) 凸眼(眼球突出)
- Enlarged thyroid (toxic goiter) 甲状腺肿⼤大(中毒性甲状腺肿)
• Treatments: Radioactive iodine, surgical removal of

thyroid gland, and anti-thyroid drugs
治疗:放射性碘，⼿手术切除甲状腺，抗甲状腺药物
23
http://www.hakeem-sy.com/main/node/15511
Hypothyroidism vs Hyperthyroidism
甲狀狀腺功能亢進
甲狀狀腺功能減退
Endemic goiter Toxic goiter
Hypothyroidism Hyperthyrodism
Serum T3 and T4 levels Low High
Metabolic rate Low High
Goiter Endemic goiter Graves’ disease
Skin Pale and cool Flushed and warm
Temperature tolerance Intolerance to cold Intolerance to heat
Eyes No changes Exophthalmos with Graves’
disease
Cardiovascular Slow heart rate Fast heart rate
(bradycardia); Enlarged (tachycardia); Increased
heart blood pressure
Nervous system Slow intellectual functions Restless and nervous
Body weight Weight increases Weight decreases
Appetite decreases Appetite increases
24
Diagnostic tests for thyroid disorders
• Examination of T3 and T4 levels

in blood
• Testing of serum TSH levels
• Uptake of radioactive iodine
• CT scans for presence of tumor

nodules in thyroid gland
CT扫描是否存在甲状腺肿瘤结节
http://women.webmd.com/ss/slideshow-thyroid-symptoms-and-solutions
25
http://firsthealthassociates.com/health-topics/thyroid-disorders-overview-by-ric-saguil-md--faafp.html
Case study: Acromegaly
• Acromegaly can lead to uncontrolled growth in patients. Watch the following

video about Tanya Angus (who was diagnosed with acromegaly at the age of 22)
and then answer the following questions (http://vimeo.com/53799719):
• What was the cause of Tanya’s condition? What are the characteristics of
patients with acromegaly?
• What therapies were used to treat Tanya’s condition? Can you suggest why those
treatments were not successful in her case?
26
http://www.acromegalycommunity.com/blog
Chapter 2: Disorders of parathyroid glands and
adrenal glands
• Understand the role of parathyroid glands as an
endocrine organ to control calcium homeostasis
了了解甲状旁腺作为内分泌泌器官在控制钙稳态中的作⽤用
• Describe how parathyroid hormone and calcitonin
can regulate blood Ca2+ levels
描述甲状旁腺激素和降钙素如何调节⾎血液Ca2+⽔水平
• Describe the causes, symptoms and treatment

strategies of various parathyroid disorders (hypo-
and hyper-parathyroidism)
描述各种甲状旁腺疾病(甲状旁腺功能减退症和甲
状旁腺功能亢进症)的病因、症状和治疗策略略
• Describe the structure and function of adrenal
glands
描述肾上腺的结构和功能
• Understand the pathophysiology of various adrenal

disorders (e.g. pheochromocytoma, Cushing’s
syndrome, and Addison’s disease)
了了解各种肾上腺疾病(如嗜铬细胞瘤、库 http://pituitary.ucla.edu/body.cfm?id=54 1
欣综合征和阿狄森⽒氏病)的病理理⽣生理理学 http://www.parathyroid.com/osteoporosis.htm
Parathyroid glands
• Parathyroid glands are 4 round

masses of tissue located at the
posterior surface of thyroid
甲状旁腺是位于甲状腺后表⾯面的4个圆形肿块组织
• Major function is to secrete

parathyroid hormone (PTH) which
increases blood Ca2+ levels
主要功能是分泌泌甲状旁腺激素(PTH)，增加⾎血液Ca2+⽔水平
• PTH and calcitonin represent two

important hormones for calcium
homeostasis
PTH和降钙素是钙稳态的两种重要激素
2
Saladin, (2010) Human Anatomy, 3rd Ed (McGrawHill Pub)
Parathyroid hormone (PTH)
• PTH is secreted from parathyroid

gland in response to low blood Ca2+
levels via membrane Ca2+ receptors
甲状旁腺分泌泌甲状旁腺通过膜
Ca2+受体响应低⾎血Ca2+⽔水平
PTH通过以下⽅方式增
• PTH increases plasma 2+
Ca by: 加⾎血浆Ca2+:
1. ↑ bone resorption by osteoclasts
(bone-breaking cells) 破骨细胞对骨吸收的影响
(碎骨细胞)
 Releasing Ca2+ from bone to blood
Releasing Ca2+ 从骨头到⾎血液
2. ↑ Ca2+ reabsorption in kidneys

↑肾脏内Ca2+再吸收
3. Stimulating kidneys to synthesize

刺刺激肾脏合成
calcitriol (active vitamin D) 骨化三醇(活性维⽣生素D)
 ↑ absorption of Ca2+ from food
↑ Ca2+ 从食物吸收
3
http://www.studyblue.com/notes/note/n/anp-ii-ch-16-endocrine/deck/5468379
How PTH and calcitonin regulate blood Ca2+ levels?
PTH和降钙素如何调节⾎血液Ca2+⽔水平?
• PTH and calcitonin are antagonistic (opposing) hormones

PTH和降钙素是拮抗(对立)激素
4
http://e-enm.org/ViewImage.php?Type=F&aid=200574&id=F1&afn=2008_ENM_26_1_25&fn=enm-26-25-g001_2008ENM
为什什么维持⾎血液Ca2+很重要?
Why maintenance of blood Ca2+ is important?
Ca2+ ions are required for:

Ca2+离⼦子需要:
• Bone and teeth formation

骨骼和牙⻮齿的形成
• Neurotransmitter release from neurons

神经递质从神经元释放
• Muscle contraction and normal heart

beat
肌⾁肉收缩和正常的⼼心
跳
• Formation of blood clot
⾎血栓的形成
• Signal transduction (as second

messengers)
信号转导(第⼆二信使)
5
https://ufhealth.org/calcium-diet
Parathyroid disorders
6
甲狀狀旁腺功能減
Parathyroid disorder: Hypoparathyroidism 退
• Hypoparathyroidism (lack of PTH) may be due to:

1. Primary hypoparathyroidism:
- Lack of parathyroid glands at birth 出⽣生时没有甲状旁腺
2. Secondary hypoparathyroidism:
- Surgery or radiation in the neck region 颈部⼿手术或放疗
 Destruction of parathyroid glands 甲状旁腺的破坏
• Signs and symptoms: Low serum calcium levels

(hypocalcemia) 体征和症状:⾎血清钙⽔水平低(低钙⾎血症)
 Weakened cardiac muscle 减弱⼼心肌
 Increased excitability of nerves and skeletal muscle
contraction (spasms in face and hands)
增加神经和骨骼肌的兴奋性
收缩(脸和⼿手的痉挛)
• Treatment: Dietary supplement of calcium or vitamin D
治疗:饮食中补充钙或维⽣生素D
http://health.doctissimo.com/medical-encyclopedia/thyroid-parathyroid- 7
http://www.bmj.com/content/336/7656/1298?ijkey=kN/189nWkD8aw&keytype=re
disorders/hypoparathyroidism.html f&siteid=bmjjournals
Parathyroid disorder: Hyperparathyroidism
• Cause: Hyperparathyroidism is due to

overproduction of PTH  High blood Ca2+ 增⽣生
levels 是由於過剩的
PTH
再吸收，钙和磷被释
放到⾎血液中
• The cause can be primary or secondary:

1. Primary hyperparathyroidism
- Caused by abnormal parathyroid glands
- Parathyroid adenoma (benign tumor)
- Hyperplasia (enlargement of
parathyroid glands)
增⽣生(甲状旁腺增
⼤大)
8
http://medical-dictionary.thefreedictionary.com/Hyperparathyroidism
2. Secondary hyperparathyroidism
- Caused by other diseases 由其他疾病引起的低钙
⾎血症(如肾脏不能重新吸
associated with hypocalcemia 收Ca2+或维⽣生素D缺乏)
(e.g. failure of kidneys to reabsorb
Ca2+ or vitamin D deficiency)
 Parathyroid glands are
stimulated to produce more PTH
甲状旁腺被刺刺激产⽣生更更多的甲状旁腺激素
9
http://mulicia.pixnet.net/blog/post/26324261-%5Bmedscape%5D%5Beducation-nephrology%5Dare-we-doing-more-harm-than-
• Cause: Adenoma (benign tumor), hyperplasia, or

renal failure 病因:腺瘤(良性肿瘤)、增⽣生、肾功能衰竭
 Excess PTH secretion 甲状旁腺素分泌泌过剩

⾼高⾎血钙⽔水平(⾼高钙⾎血症)
- High serum calcium levels (hypercalcemia)
- Osteoporosis (fracture) 骨质疏松症(骨折)
- Forceful contractions of cardiac muscle ⼼心肌强有⼒力力的收缩
- Kidney stones
http://www.menopausehealthmatters.com/osteoporosis-and-menopause.html
http://iahealth.net/are-you-at-risk-for-having-kidney-problems-later-in-life-because- 10
http://country-physician.blogspot.hk/2010/12/prevent-and-dissolve-kidney-
youve-had-a-kidney-stone-the-answer-may-surprise-you/ stones.html
How to treat hyperparathyroidism?
如何治疗甲状旁腺功能亢进?
• Treatment options will depend on

the cause
治疗⽅方案将取决于病因
• Primary hyperparathyroidism
(e.g. adenoma) 原发性甲状旁腺功能亢进(如腺瘤)
 Surgery
• Secondary hyperparathyroidism
(e.g. renal disease) 继发性甲状旁腺功能亢进
(如肾脏疾病)
 Ca or vitamin D supplements
2+
http://www.costco.com/Caltrate%C2%AE-600%2BD3-Calcium-%2526-Vitamin-D3- 11
Supplement,-320-Tablets.product.100029234.html http://www.ghorayeb.com/Parathyroidundescended.html
Adrenal glands
12
Adrenal glands
• Consist of two endocrine organs: adrenal cortex
(outer) and adrenal medulla (inner)
由两个内分泌泌器官组成:肾上腺⽪皮质(外)和肾上腺髓质(内)
• Adrenal cortex: Endocrine cells 肾上腺⽪皮质:内分泌泌细胞

Adrenal medulla: Neuroendocrine cells (sympathetic
nervous system) 肾上腺髓质:神经内分泌泌细胞(交感神经)
神经系统)
• Adrenal medulla secretes 2 major amine hormones

肾上腺髓质分泌泌2种主要
(catecholamines): 胺类激素(⼉儿茶茶酚胺)
1. Epinephrine 肾上腺素
2. Norepinephrine 去甲肾上腺素
• Adrenal cortex secretes 3 groups of steroid hormones

(corticosteroids): 肾上腺⽪皮质分泌泌3组类固醇激素(⽪皮质类固醇)
1. Mineralocorticoids (e.g. aldosterone) 盐⽪皮质激素(如醛固酮)
2. Glucocorticoids (e.g. cortisol) 糖⽪皮质激素(如⽪皮质醇)
3. Androgens (e.g. testosterone) 雄激素(如睾酮) 13
http://divinehealthfromtheinsideout.com/2012/08/how-blood-sugar-affects-the-adrenals-endocrine-system/
Adrenal medulla and catecholamines
(epinephrine and norepinephrine)
肾上腺髓质和⼉儿茶茶酚胺(肾上腺素和去甲肾上腺素)
• Consists of neuroendocrine chromaffin

cells that secrete epinephrine and
norepinephrine (synthesized from
tyrosine) to bloodstream
由神经内分泌泌嗜铬细胞组成，分泌泌肾上腺
素和去甲肾上腺素(由酪氨酸合成)到⾎血液
• Secretion is stimulated by sympathetic
nervous system in response to stress
压⼒力力反应时，交感神经系统刺刺激分泌泌
• Stress  Impulses from hypothalamus 

Sympathetic pre-ganglionic neurons 
交感神經的節前神經元
Chromaffin cells  Epinephrine and
norepinephrine
14
http://mybrainnotes.com/serotonin-dopamine-epinephrine.html http://courses.washington.edu/conj/bess/neuralreg/neuralreg.html
What are the functions of epinephrine and
norepinephrine?
肾上腺素和去甲肾上腺素刺刺激“战或
逃”反应，使⾝身体为⾝身体活动做好准备
• Epinephrine and norepinephrine stimulate
the fight-or-flight response, which prepares
body for physical activity by:
↑ Cardiovascular functions (heart rate and
blood pressure) ⼼心⾎血管功能(⼼心率和⾎血压)
↑ Blood glucose and fatty acid levels
⾎血糖和脂肪酸⽔水平
↑ Metabolic rate
↑ Vasodilation in muscle (but
vasoconstriction in other tissues)
肌⾁肉⾎血管舒张(其他组织⾎血管收缩)
15
http://www.simplypsychology.org/stress-biology.html
由三层内分泌泌细胞组成，分泌泌
Adrenal cortex and corticosteroids 肾上腺⽪皮质和⽪皮质激素
各种⽪皮质类固醇(由胆固醇合成)
• Consists of 3 layers of endocrine cells that
secrete various corticosteroids
(synthesized from cholesterol):
1. Outer cortex 盐⽪皮质激素(如醛固
酮) aldosterone)
- Mineralocorticoids (e.g.
- Na+ reabsorption and K+ excretion in
kidneys Na+再吸收和K+排泄于肾脏
- Maintenance of blood pressure
球狀狀帶醛固酮
维持⾎血压
2. Middle cortex 糖⽪皮质激素(如⽪皮质醇)

- Glucocorticoids (e.g. cortisol) 束狀狀帶⽪皮质醇
和雄激
- Long-term stress response ⻓长期的应激反应素
3. Inner cortex
網狀狀帶
- Androgens (e.g. testosterone) 雄激素(如睾酮)
- Sexual characteristics in male; sex drive
in female 男性的性特征;女性的性冲动
16
http://www.georgiahealth.edu/medicine/phy/raineylab/objective.html
Aldosterone secretion is mainly regulated by renin-
angiotensin system
17
http://classes.midlandstech.edu/carterp/Courses/bio211/chap16/chap16.htm
Regulation of cortisol secretion from adrenal cortex
(hypothalamus-pituitary-adrenal axis)
肾上腺⽪皮质(下丘脑-垂体-肾上腺轴)⽪皮质醇分泌泌的调节
• Cortisol secretion is regulated

primarily by adrenocorticotropic
hormone (ACTH) released from
anterior pituitary
⽪皮质醇的分泌泌主要由垂体前叶释放的
促肾上腺⽪皮质激素(ACTH)调节
• ACTH is in turn regulated by
corticotropin-releasing hormone
(CRH) released from hypothalamus
ACTH由下丘脑释放的促肾上腺
⽪皮质激素释放激素(CRH)调节
• Excess cortisol can inhibit CRH and
ACTH secretion from respectively
from hypothalamus and anterior
pituitary (-ve feedback)
过多的⽪皮质醇可分别抑制下丘脑和垂体前
叶CRH和ACTH的分泌泌(-ve反馈)
18
Short-term and long-term stress response are mediated by
catecholamines and corticosteroids respectively
19
Adrenal disorders
20
Disorders of adrenal medulla: Pheochromocytoma
肾上腺髓质疾病:嗜铬细胞瘤
• Cause: A benign tumor of adrenal

medulla that secretes
epinephrine and norepinephrine
病因:肾上腺髓质分泌泌肾上腺素和
去甲肾上腺素的良性肿瘤
Hypertension 體徵和症状:⾼高⾎血压
 Headache, heart palpitations,
sweating, and anxiety
头痛、⼼心悸、出汗和焦虑
• Treatment: Surgery
21
http://www.webpathology.com/image.asp?case=83&n=1
肾上腺⽪皮质紊乱:库欣综合征
Disorders of adrenal cortex: Cushing’s syndrome

• Cause: Excessive serum glucocorticoids (e.g. cortisol),
which may result from: 病因:⾎血清糖⽪皮质激素(如⽪皮质醇)过多
- Adrenal (or pituitary) adenoma 腎上線腫瘤
- Ectopic cancer (e.g. lung cancer with ACTH
secretion) 异位癌(例例如:分泌泌促肾上腺⽪皮质激素的肺癌)
- Administration of glucocorticoids for treating
chronic inflammation (iatrogenic effect)
糖⽪皮质激素治疗慢性炎症(医源性作⽤用)

脸肿，⿐鼻⼦子重;⽪皮肤有红⾊色条纹
- Puffy face and heavy trunk; skin with red streaks
- Osteoporosis 骨质疏松症
增加糖异⽣生和胰岛素抵抗
- Increased gluconeogenesis and insulin resistance
 Diabetes mellitus 糖尿尿
病
• Treatment: Surgery or avoid glucocorticoid treatment

治疗:⼿手术或避免糖⽪皮质激素治疗
22
http://medlibes.com/entry/cushings-syndrome http://medicalpicturesinfo.com/cushing%E2%80%99s-syndrome/
Exercise: How does serum ACTH change with serum
cortisol in patients with Cushing’s syndrome?
Cause Serum ACTH Serum Cortisol

Pituitary tumor ↑
Adrenal cortex tumor ↑
Ectopic cancer (e.g. ↑
Lung cancer)
Iatrogenic (e.g. ↑
cortisol intake)
23
Disorders of adrenal cortex: Addison’s disease
肾上腺⽪皮质紊乱:阿狄森⽒氏病
病因:⾃自⾝身免疫性或病毒性疾病引起的糖⽪皮质激素缺乏
• Cause: Deficiency of glucocorticoids due to
autoimmune or viral disease

- Decreased blood glucose levels 降低⾎血糖⽔水平
- Poor stress response
- Fatigue and weight loss 疲劳和减肥
- Hypotension 低⾎血压
- Hyperpigmentation ⾊色素沉着过度
• Treatment: Hormone replacement therapy

治疗:激素替代疗法
24
http://manningbiography.wikispaces.com/John+Kennedy
Chapter 3: Disorders of the pancreas
• Understand the role of pancreas
as both an endocrine and an
exocrine organ
了了解胰腺作为内分泌泌器官和外分泌泌器官的作⽤用
• Describe the causes, symptoms,

and treatment methods of Type 1
and Type 2 diabetes
描述1型和2型糖尿尿病的病因、症状和治疗⽅方法
• Understand the acute and chronic

complications of diabetes
了了解糖尿尿病的急性和慢性并发症
http://technorati.com/lifestyle/article/is-diabetes-a-health- 1
verdict-for/ http://healthtipsinsurance.com/stories/21298/Cystic-Neoplasm-Of-Pancreas-RAPID-REVIEW.html
Pancreas
• A glandular endocrine organ situated

between stomach and duodenum
位于胃和⼗十⼆二指肠之间的腺体内分泌泌器官
• Performs both endocrine (hormonal)

and exocrine (enzymatic) functions
执⾏行行内分泌泌(激素)和外分泌泌(酶)功能
• Endocrine: Islets of Langerhans secrete

hormones into blood vessels
内分泌泌:胰岛分泌泌激素进入⾎血管
• Exocrine: Acinar cells secrete enzymes

and ductal cells secrete bicarbonate
ions into pancreatic duct
外分泌泌:腺泡细胞分泌泌酶，导管细胞分泌泌碳酸氢盐离⼦子进入胰管
2
http://www.gopetsamerica.com/anatomy/pancreas.aspx
内分泌泌胰腺位于兰格罕的胰岛
Pancreatic islets and hormones
中，散布在更更多的外分泌泌细胞
(腺泡和导管细胞)中。
• The endocrine pancreas resides in the islets of
Langerhans scattered throughout the more numerous
exocrine cells (acinar and ductal cells)
• 3 major pancreatic hormones:

1. Insulin
- Secreted by β cells
- ↓ blood glucose levels
2. Glucagon 胰⾼高⾎血糖素
- Secreted by α cells
- ↑ blood glucose levels
3. Somatostatin
素䅁
抑制
激素
⽣生⻓长
- Secreted by δ cells
- Inhibits release of other pancreatic hormones http://droualb.faculty.mjc.edu/Course%20Materials/Physiology
3
%20101/Chapter%20Notes/Fall%202011/chapter_6%20Fall%20
抑制其他胰腺激素的释放 2011.htm
Pancreatic enzymes
• 4 major types of pancreatic enzymes:
1. Amylase
酶
淀粉
- Catalyzes the breakdown of starch 催化淀粉的分解
2. Proteases (e.g. trypsin) 蛋⽩白酶(如胰蛋⽩白酶)

- Break down proteins into peptides
- Secreted as an inactive form (e.g.
trypsinogen) 以非活性形式分泌泌(如胰蛋⽩白酶原)
3. Lipase 脂肪酶
- Digests lipids and fats into fatty acids
and glycerol 将脂类和脂肪分解成脂肪酸和⽢甘油
4. Nucleases 核酸酶
- Digest DNA and RNA
消化DNA + RNA 4
Saladin, (2010) Human Anatomy, 3rd Ed (McGrawHill Pub)
Pancreatic disorders
5
Pancreatic disorders: Diabetes mellitus
胰腺疾病:糖尿尿病
• A heterogeneous disorder defined by the

presence of hyperglycemia 以⾼高⾎血糖为特征的异质性疾病 glucometer
• Causes:
1. Type 1
- Deficit of insulin secretion from β cells of
pancreatic islets 胰島素的虧損從细胞的胰島素
β
2. Type 2
insulin resistance
- Lack of response by cells to insulin 细胞对胰岛素缺乏反应
3. Gestational 妊娠期
- Induced by pregnancy 由怀孕引致
6
http://www.hatfindo.com/wp-content/uploads/2010/03/Diabetes-mellitus.jpg
Type 1 diabetes mellitus (insulin-dependent)
1型糖尿尿病(胰岛素依赖型)
• Due to destruction of pancreatic β cells in

an autoimmune reaction Insulin deficit
由于⾃自体免疫反应破坏胰腺β细胞︎︎——胰岛素虧損
• Much less common (≈ 10% of all diabetes)

than Type 2 diabetes 比2型糖尿尿病少很多(约占所有糖尿尿病的10%)
• Occurs more frequently in children and

adolescents (≈ 1 in 500) juvenile diabetes
青少年年糖尿尿病
• A major factor for strokes, heart attacks,

lower leg amputation, kidney failure, and
blindness diabetic foot
中⻛风、⼼心脏病、下肢截肢、肾衰竭和失明的主要因素
• Treatment: Insulin injection
7
http://www.diabetesresearch.org/what-is-type-one-diabetes
2型糖尿尿病(非胰岛素依赖型)
Type 2 diabetes mellitus (noninsulin-dependent)
• Type 2 diabetes may involve:

⾝身体细胞对胰岛素的抵抗
1. ↑ resistance by body cells to
insulin hyporesponsiveness低反應性: can’t sense
insulin——low insulin insensitivity
2. ↓ β cell producƟon fat/proteins --> glucose
3. ↑ glucose producƟon by liver
因為⾝身體時常感到沒有glucose，所以liver 會製造很多。
liver 可以通過 breakdown of glycogen (glycogenolysis) 去減少glucose。 (gluconeogenesis )
• Often develops gradually in older

adults (≈ 50% cases found in people >
55 years old), most are overweight
通常在老年年⼈人中逐渐发展(在55岁的⼈人群中发现≈50%的病例例)，⼤大多数是超重的
• Excess fat makes it harder for cells to

respond to insulin ↑ insulin
resistance in people with obesity
过多的脂肪使细胞更更难应对胰岛素————︎︎↑在肥胖患者胰岛素抵抗
insulin receptor 不能感覺到insulin

8
http://we-care-you.blogspot.hk/2013/08/type2-diabetes.html
Gestational diabetes
病
糖尿尿
妊娠
• A form of glucose intolerance which
occurs during pregnancy and
disappears after delivery ⼀一种葡萄糖耐受不良，发⽣生
于怀孕期间，分娩后消失
• Affects ≈ 10% of all pregnancies

胎盘激素(如雌激素)⼲干扰胰岛素功能------︎︎↑⾎血糖
• Placental hormones (e.g. estrogen)
interfere insulin function ↑ blood
glucose
estrogen and progesterone ——hormone 功能是maintain the thickness of the uterine lining (endometrium)
• Newborns are usually overweight
9
http://www.medindia.net/slideshow/pregnancy-diabetes-mellitus.asp#4
Pathophysiological symptoms of diabetes (1)
糖尿尿病的病理理⽣生理理症状(1)
• Blood glucose levels rise (hyperglycemia) ⾼高⾎血糖
• Excess glucose appears in the urine (glucosuria) 糖尿尿病
• Glucose in urine exerts osmotic pressure in the

glomerular filtrate Large volume of urine to
be excreted (polyuria) 尿尿液中葡萄糖产⽣生渗透压的肾⼩小球滤
液︎︎⼤大量量排出的尿尿液(多尿尿）
• Loss of water and high blood glucose levels

draw water from the cells Dehydration
Thirst (polydipsia) 损失的⽔水和⾼高⾎血糖⽔水平提取⽔水
从细胞----︎︎脱⽔水︎︎-----⼝口渴(烦渴)
• Decreased use of glucose in many cells of the

body (starvation) ⾝身体许多细胞对葡萄糖的利利⽤用减少(饥饿)
• Lack of nutrients entering the cells stimulates

appetite (polyphagia) 多食症
10
http://www.foods-healing-power.com/type-2-diabetes-symptoms.html
Pathophysiological symptoms of diabetes (2)
• Lack of glucose in cells 缺乏葡萄糖细胞
Breakdown of fats 分解脂肪
Ketone bodies (acetone or ketoacids) in
the blood ⾎血液中酮体(丙酮或ketoacids)
• Ketone bodies are important fuel for the

brain and heart during starvation or in
diabetic patients 在饥饿或糖尿尿病患者中，酮体是⼤大脑和⼼心脏的重要燃料
⾎血液中多余的酮体
• Excess ketone bodies in the blood Bind减少体液的酸碱度
serum bicarbonate Decrease pH of body
fluids Ketoacidosis normal PH: 7.35-7.45
diabetes mellitus PH：？
酮症酸中毒
• Excess ketone bodies are excreted in urine

(ketonuria) or exhaled in breath (fruity
acetone breath) 多余的酮体通过尿尿液排出(酮尿尿)
或通过呼吸呼出(果香丙酮呼吸)
11
http://www.diabetestreatmentguide.org/prevent-diabetic-ketoacidosis-
acetone = volatile organic compounds (VOCs) using-5-simple-steps/
Ketone bodies
• 2 out of 3 ketone bodies are carboxylic acids
12
http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-i
Fill in the blanks: Summary of diabetic symptoms
Decreased insulin secretion or increased insulin-resistant cells
glucose
Decreased __________ transport into cells
___________
starvation ______________
hyperglycemia Release of glucose Breakdown
(hunger) (high blood from the liver by of fats
glucose) glycogenolysis and
_________________
gluconeogenesis
ketone bodies
__________________
glucosuria ____________
(ketogenesis)
(excess glucose in
urine)
polydipsia
___________ Polyuria (large volume of urine) __________
ketoacidosis Ketonuria
(thirst)
Dehydration
13
Diagnosis and treatment for
diabetes
14
Diagnostic tests for diabetes (1)
1. Fasting blood glucose level 空腹⾎血糖⽔水平
- Can be monitored at home by a portable
glucometer 可在家中由便便携式⾎血糖仪监测
- Diabetes: ≥ 7 mmol/L (more than once)
2. Glucose tolerance test 葡萄糖耐量量试验

- Fasting for 8 h and blood is taken 禁食8⼩小时，抽⾎血
- Intake of glucose drink (e.g. 75 g) and
then blood is collected after 2 hours
摄入葡萄糖饮料(如75
- Diabetes: ≥ 11 mmol/L (2 h) 克)，2⼩小时后采⾎血。
糖化⾎血红蛋⽩白(HbA1c)试验
3. Glycosylated hemoglobin (HbA1c) test
表⽰示过去三个⽉月
- Indicates an average of blood glucose 的平均⾎血糖⽔水平
levels over the past 3 months
because hemoglobin is
- Diabetes: > 7% circulate around 3months
Glycosylation 糖基化 15
http://www.hatfindo.com/wp-content/uploads/2010/03/Diabetes-mellitus.jpg
Diagnostic tests for diabetes (2)
4. Glucose challenge test (for gestational 葡萄糖挑战试验(⽤用于妊娠糖尿尿病;代谢途径)
diabetes; 26-28 week)
- No fasting required 不需要禁食
- A glucose drink (e.g. 50 g) is given and then
blood is taken after 1 h 给予葡萄糖饮料(如50克)，1⼩小时后采⾎血
- Diabetes: ≥ 7.8 mmol/L (confirmed by glucose
tolerance test)
5. Urine tests for ketones (for patients with

ketoacidosis) 尿尿酮检查(酮症酸中毒患者)
- Dip test strip into urine and compare it with
the color chart 将试纸浸入尿尿液中，并与⾊色卡对比
http://www.drugs.com/cg/ketones-urine.html
16
http://www.medindia.net/slideshow/pregnancy-diabetes-mellitus.asp#4
Treatments for diabetes (1)
• Four levels of control: reduce of absorption cholesterol

1. Diet 3 low 1 high eating principle
- ↓ food/calorie intake
- Complex carbohydrates with low
glycemic index ⾎血糖指数低的复合碳⽔水化合物
- Food with low cholesterol and lipid
levels 低胆固醇和低脂质的食物
- ↑ fiber intake
吃太多carbohydrate, 會轉化為monosaccharides (glucose)
2. Exercise
- ↑ uptake of glucose by muscles 肌⾁肉对葡萄糖的吸收
- ↓ weight and stress

- ↑ cardiovascular function
17
http://health.allrefer.com/pictures-images/diabetes-and-exercise.html https://ufhealth.org/diabetes-diet-type-1
Treatments for diabetes (2)
3. Oral medications ⼝口服藥物

- Drugs that reduce insulin 减少胰岛素抵抗的药物(如⼆二甲双胍)
resistance (e.g. metformin)
- Drugs that stimulate insulin
release from β cells of pancreas
(e.g. sulphonylurea or Diabeta®)
药物刺刺激胰腺β细胞的胰岛素释放(如磺脲或Diabeta®)
4. Insulin replacement
- Recombinant insulin (Humulin)
synthesized by bacteria 细菌合成重组胰岛素(Humulin)
- Must be injected subcutaneously
(why?)
為什什麼胰島素是打針進去，⽽而不是吃進去？因為protein hormone
http://www.healthline.com/hlcmsresource/images/imce/pregnancy-metformin-is-it-safe_thumb.jpg 18
http://www.odec.ca/projects/2007/wood7a2/timeline.htm http://www.drugs.com/pro/diabeta.html
Acute and chronic complications
for diabetes
糖尿尿病的急性和慢性并发症
19
Acute complications for diabetes: Hypoglycemia
(insulin shock) 糖尿尿病急性并发症:低⾎血糖(胰岛素休克)
• Due to excess insulin injection

Low blood glucose Decreased
CNS function Weakness and
confusion 因为注射了了过多的胰岛
素---⾎血糖低——︎︎降低中枢
神经系统功能︎︎软弱和困惑
• Occurs following vigorous exercise,

low food intake etc.
发⽣生在剧烈运动、低食物摄入量量等
• Can cause brain damage or death
• Treated by concentrated
carbohydrate (e.g. fruit juice or
candy) or intravenous injection of
glucose or glucagon ⽤用浓缩碳⽔水化合物(如果汁或糖果)或静
脉注射葡萄糖或胰⾼高⾎血糖素处理理
20
http://www.buzzle.com/articles/how-to-treat-insulin-shock.html
糖尿尿病的急性并发症:糖尿尿病酮症酸中毒
Acute complications for diabetes: Diabetic ketoacidosis
• Due to insufficient insulin; common in Type

1 patients 胰岛素不⾜足;在1型病⼈人中很常⻅见
• Progressive signs: Hyperglycemia Polyuria

Dehydration Ketoacidosis Coma
进步的迹象:⾼高⾎血糖,︎︎多尿尿症,︎︎脱⽔水,︎︎酮症酸中毒︎︎和昏迷
• Effects of ketoacids in blood:

1. Acetone breath 丙酮⽓气碳酸氢盐⾎血液结合,︎ ︎Decreased⾎血
清pH值、︎︎失去意识
2. Bind bicarbonate in blood Decreased
serum pH Loss of consciousness
腹痛、恶⼼心和呕吐
3. Abdominal pain, nausea and vomiting lipolysis
4. Rapid and deep breathing 快速呼吸
• Treated by administration of insulin and

bicarbonate bicarbonate can react with ketoacids
⽤用胰岛素和碳酸氢盐治疗 21
http://ncpnanda.blogspot.hk/2013/01/fluid-volume-deficit-related-to.html
Chronic complications of diabetes: Microangiopathy
微⾎血管病
阻塞和⽑毛细⾎血管破裂或⼩小动脉
——︎︎坏死——︎︎损失功能
• Obstruction and rupture of
capillaries or small arteries
Necrosis Loss of function
变
膜病
視⽹网
• Retinopathy
视⽹网膜⽑毛细⾎血管破裂
- Capillaries in retina rupture
出⾎血貧⾎血
Blindness
• Nephropathy 腎病 ultrafiltration
变性肾脏的肾⼩小球——︎︎肾功能衰竭
- Degeneration of glomeruli in
kidney Renal failure Bowman's
capsule
glomerulu
s
Bowman's capsule 22
http://www.cram.com/cards/path-spring-images-1751891 urine http://health.rush.edu/healthinformation/care%20guides/28/000289.aspx
糖尿尿病的慢性并发症:⼤大⾎血管病变
Chronic complications of diabetes: Macroangiopathy
• Blockage and rupture of large

arteries ⼤大动脉阻塞和破裂
cholesterol plaque
Heart attacks and strokes
hyperglycemia ⾼高⾎血糖
endothelial cells
glycated proteins and lipids
glycation (glycosylation)
23
http://health.rush.edu/healthinformation/care%20guides/28/000289.aspx
Chronic complications of diabetes: Neuropathy
糖尿尿病的慢性并发症:神经病
• Peripheral neuropathy can lead to

impaired sensation, numbness,周围神经病变可导致感觉受损、
⿇麻⽊木、刺刺痛和肌⾁肉萎缩
tingling, and muscle wasting
• Increased risks of tissue damage

and infection if vascular 如果⾎血管损伤和感觉损
impairment and sensory 伤同时存在，组织损伤
和感染的⻛风险增加
impairment coexist
⾃自主神經退化
• Autonomic nerve degeneration
Urinary incontinence 尿尿失禁
Impotence or infertility
陽痿/不孕
24
http://www.health.com/health/incontinence-woman/ http://tootallfritz.com/2012/05/22/neuropathy-awareness-run/
Chronic complications of diabetes: Infections
糖尿尿病的慢性并发症:感染
• Macroangiopathy and increased

glucose levels favor infections
⼤大⾎血管病变和葡萄糖⽔水平升⾼高有利利于感染
• Diabetic foot: Infections in feet and

legs tend to persist because healing
is slow Ulcer Gangrene
Amputation
⽂文字
• Fugal infections (e.g. Candida

albicans): Persist in body folds, oral
cavity, and vagina
⽂文字
http://www.everydayhealth.com/diabetes-pictures/10-diabetic-skin- 25
problems.aspx#/slide-3 http://www.specialistvascularclinic.com.au/peripheral-vascular-disease.html
Chronic complications of diabetes: Cataracts
⽩白內障
• Cataract = Clouding of the lens of the
eye 眼睛晶状体的混浊
hydroxyl groups
• Due to abnormal metabolism of

glucose Accumulation of sorbitol
and water in the lens 由于异常代谢葡萄糖——积
累⼭山梨糖醇与⽔水的镜头
Reduced transparency in the lens ︎减少晶状体的透明度︎︎
Blindness
• Treatment: Cataract extraction

治疗:⽩白内障摘除
26
http://www.varga.org/Physician%20Assistant%20Photos.htm http://www.sightsurgeryinternational.com/cataracts_explained.html
Clinical case study
• Mr. F. was diagnosed with Type 2 diabetes at age 46.

• Overweight, enjoyed foods with high carbohydrate and fat content.
• Family history: Mother and brother had diabetes.
1. What would you recommend him to do so as to lower his blood glucose

levels?
dietary control + : drugs that reduce insulin resistance (or stimulate insulin release)
例例如：metformin
2. List the factors which may contribute to diabetes in Mr. F.
3. At the age of 50, Mr. F. found that his vision was cloudy in one eye. What
could be the problem? Explain how such a complication arises and
suggest a possible treatment.
Cataracts
27
Modified from: Gould and Dyer. Pathophysiology for the Health Professions. 4th Ed., Saunders Elsevier
Chapter 4: Male and female reproductive systems and
their disorders
男性和女性⽣生殖系统及其失调
• Identify the structure and function of
various organs in the male and female
reproductive systems 识别男性和女性⽣生殖系统
中各种器官的结构和功能
• Describe the functions of male and

female sex hormones and how their
levels are regulated
描述男性和女性性激素的功能以
及它们的⽔水平是如何调节的
• Explain the causes, symptoms, and
treatments of common reproductive
disorders
解释常⻅见⽣生殖障碍的原因、症状和治疗⽅方法
1
http://www.virtualmedicalcentre.com/anatomy/male-reproductive-system-male-urogenital-system/10
Why reproduction is important?
为什什么繁殖很重要?
• Characteristic of life
⽣生命的特征
• Survival of the species

物种的⽣生存
• Sexual reproduction can generate

genetic diversity  Driving force for
evolution
有性⽣生殖可以产⽣生遗传多样性————是进化的动⼒力力
2
http://www.docstoc.com/docs/126383420/Human-Reproduction---Get-Now-PowerPoint
Reproductive system: An overview
• Primary reproductive organs = Gonads 初级⽣生殖器官=⽣生殖腺

- Male: Testis (testes) 男性:睾丸
- Female: Ovary (ovaries) 女性:卵卵巢(卵卵巢)
性腺有两个功能:
• Gonads have two functions: ⽣生殖细胞的
产⽣生(配⼦子)
1. Production of sex cells (gametes)
- Male: Sperm 男:精⼦子
- Female: Ovum (ova) 女性:卵卵细胞
2. Secretion of sex hormones 性激素分泌泌

- Male: Androgens (e.g. testosterone) 男性:雄激素(如睾酮)
- Female: Estrogens (e.g. estradiol) 女性:雌激素(如雌⼆二醇)
• Estrogens are not unique to females, nor are

androgens to males
雌性激素不是女性独有的，雄性激素也不是男性独有的
3
http://kids.britannica.com/elementary/art-89496/Men-and-women-have-different-reproductive-organs
繁殖控制的⼀一般模式。
General pattern of reproduction control
• Reproductive function is controlled by

a chain of hormones
⽣生殖功能由⼀一系列列激素控制
• Gonadotropin-releasing hormone
(GnRH) is secreted from the
neuroendocrine cells of hypothalamus
促性腺激素释放激素(GnRH)由下丘脑的神经内分泌泌细胞分泌泌
• Anterior pituitary  FSH and LH 

Gametes and sex hormones in gonads
垂体前叶----FSH和LH----⽣生殖腺中的配⼦子和性激素
• Sex hormones  -ve feedback effects

on secretion of GnRH, FSH, and LH
性激素——对GnRH、FSH、LH分泌泌的负反馈作⽤用
4
Vander A., Sherman, J and Luciano, D. (2010) Human Physiology, 12th ed. (McGraw Hill)
Male reproductive system
Overview of male reproductive system
• Testes (production of sperm and testosterone)
睾丸(产⽣生精⼦子和睾丸激素)
管道系统(储存和运输
• A system of ducts (storage and transport of 精⼦子)
sperm)
- Epididymis 附睾
- Vas deferens 輸精管ÿ
þ
- Ejaculatory ducts 射精管
- Urethra 尿尿道
副性腺(精液⽤用的精液)
• Accessory sex glands (seminal fluid for semen)
- Seminal vesicles 精囊
- Prostate 前列列腺
- Bulbourethral (Cowper’s) glands
球部尿尿道腺
• Supporting structures (sperm delivery) ⽀支持结构(精⼦子输送）
- Scrotum 阴囊
- Penis 阴茎
6
Testes
睪丸
• Suspended outside the abdomen in

scrotum
精⼩小管
悬挂于阴囊腹部外
• Sperm production requires 2-3oC

below body temperature
精⼦子的产⽣生需要低于体温2-3摄⽒氏度
• Sperm cells are produced in

seminiferous tubules
精细胞是在精⼩小管中产⽣生的
• They are stored and matured in

epididymis
它们储存在附睾中，并在附睾中成熟
7
細精管
Seminiferous tubules
間質細胞
• Three major cell types:
精⼦子发⽣生的细胞
1. Spermatogenic cells
- Sperm-forming cells
精原細胞
- Spermatogonium (2n)
精⺟母細胞
 1o spermatocyte (2n)
2o spermatocyte (n)
 Spermatid (n) 精細胞
 Sperm cell (n) 精⼦子
2. Sertoli cells 塞尔托利利⽒氏细胞

- Sperm-nurturing cells
3. Leydig cells 睾丸间质细胞

(interstitial) (间隙)
- Secrete testosterone
分泌泌睪酮
8
Tortora GJ, Derrickson BH. Principles of Human Anatomy and Physiology. 13 ed. (Wiley)
精⼦子發⽣生 + 精⼦子形成
Spermatogenesis and spermiogenesis
精⼦子發⽣生
• Spermatogenesis
- Spermatogonia (2n) 
spermatozoa (n)
精原細胞（2n)-----精細胞（n)
• Spermiogenesis
- Differentiation of
spermatids into mature
sperm cells (spermatozoa)
精⼦子细胞向成熟精⼦子细胞的分化(精⼦子)
9
Sperm
• 300 M sperm cells are produced each

day; survival < 48 h 每天产⽣生300万个精⼦子;⽣生存< 48⼩小时
• Head
- Acrosome (enzymes for sperm
penetration into egg) 顶体： (精⼦子酶
渗透到蛋)
- Nucleus (haploid; 23 chromosomes)
核(单倍体;23条染⾊色体)
• Tail
颈(中⼼心粒形成
- Neck (centrioles forming 微管)
microtubules) 中段
- Middle piece (with mitochondria (线粒体为精⼦子运动提供能量量)
provide energy for sperm movement)
- Principal piece (for swimming)
- End piece
10
荷尔蒙控制睾丸
Hormonal control of testes

下丘脑促性腺激素释放激素(GnRH)
• Gonadotropin-releasing hormone (GnRH) from
hypothalamus
 Follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) from anterior
pituitary 垂体前叶促卵卵泡激素(FSH)
和促黄体⽣生成素(LH)。
• LH  Testosterone secretion from Leydig cells

(converted into DHT in some target cells)
睾丸激素从Leydig细胞分泌泌(在某些靶细胞转化为DHT)
• FSH + Testosterone FSH +睾酮

Androgen-binding protein (ABP) from Sertoli
cells 雄激素结合蛋⽩白(ABP)来⾃自Sertoli细胞
 ↑ spermatogenesis - 男性发展模式(出⽣生前)
- 男性脏器放⼤大及男性第⼆二
性征表现(青春期开始)
- 合成代谢
• Negative feedback
- LH and FSH release is inhibited by
testosterone and inhibin respectively
LH和FSH的释放分别受到睾酮和抑制素的抑制 11
睾酮与双氢睾酮(DHT)的作⽤用
Functions of testosterone and dihydrotestosterone (DHT)

• Both are steroid hormones  Nuclear androgen receptors
 Gene activation or inhibition 两者都是类固醇激素—- 核性雄
激素受体----基因激活或抑制
• Functions:
1. Prenatal development 产前发展
- Male developmental pattern (e.g. male sex organs and
descent of testes into scrotum) before birth
男性在出⽣生前的发育模式(例例如男性性器官和睾丸进入阴囊)
2. Male sexual characteristics 男性性特征

- Muscle growth, pubic hair, enlargement of penis etc.
肌⾁肉⽣生⻓长，阴⽑毛，阴茎增⼤大等
3. Sexual functions 性的功能

- Spermatogenesis and sex drive in males and females
男性和女性的精⼦子发⽣生和性冲动
4. Anabolism 合成代谢
- ↑ Protein synthesis
12
http://bergenantiaging.com/testosterone-therapy
Disorders of the male
reproductive system
睾丸和阴囊功能紊乱
- Disorders of the testes and scrotum

- Inflammation and infection 炎症和感染
- Tumors
13
Cryptorchidism 隐睾症
在怀孕期间睾丸向阴囊的畸形
• Maldescent of the testis into the
scrotum during pregnancy
 Testes remain in abdominal
cavity 睾丸留留在腹腔内
• Causes: Hormone abnormalities

(low testosterone) or short
spermatic cord
病因：激素异常(睾丸激素低)或精索短
• Signs and symptoms: Degeneration

of seminiferous tubules; Impaired
spermatogenesis
体征和症状:精⼩小管变性;精⼦子发⽣生障碍
• Treatment: Surgical positioning of

testes in scrotum before age 2
治疗:2岁前⼿手术定位阴囊内睾丸 14
http://www.ptolemy.ca/members/archives/2010/Cryptorchidism/
Prostatitis 前列列腺炎
• Acute or chronic inflammation of

prostate gland  Swelling
前列列腺的急性或慢性炎症------肿胀
• Cause: An ascending infection

(progresses up the urethra) by
bacteria (e.g. E. coli, Pseudomonas,
or Streptococcus faecalis)
病因:细菌(如⼤大肠杆菌、假单胞菌或粪
链球菌)引起的上⾏行行感染(沿尿尿道上⾏行行)
• Signs and symptoms: Pain during
urination, reduced urinary flow,
increased urinary frequency, urine
体征和症状:排尿尿疼痛、尿尿流量量减
with bacteria and leukocytes, fever 少、尿尿频增加、尿尿中有细菌和⽩白
and chills (for acute infections) 细胞、发烧和发冷(急性感染)
• Treatment: Antibiotics (e.g. Cipro)

治疗:抗⽣生素(如⻄西普罗)
15
http://www.drugs.com/health-guide/chronic-prostatitis.html
Benign Prostatic Hyperplasia (BPH)
良性前列列腺增⽣生(BPH)
• Very common in older men; 50% of 在老年年男性中很常⻅见;65岁以上

的男性中有50%可能患有BPH
men over 65 years may have BPH
• Causes: Hyperplasia of the prostate

tissue related to imbalance between
estrogen and testosterone
病因:前列列腺组织增⽣生，与雌激素和睾酮的失衡有关
• Signs and symptoms: Enlarged

prostate gland, obstruction of urinary
flow, incomplete emptying of bladder
症状和体征:前列列腺肿⼤大，尿尿路路阻塞，膀胱排空不全
• Treatment: Surgery, drugs to reduce

androgenic effects, or drugs to relax
smooth muscle in prostate and
bladder 治疗:⼿手术、降低雄激素作⽤用的药物、
或放松前列列腺和膀胱平滑肌的药物 16
http://en.wikipedia.org/wiki/Benign_prostatic_hyperplasia
Prostate cancer 前列列腺癌
• Common in men > 50 years old; 3rd leading

cause of death from cancer in men
常⻅见于50岁男性;男性癌症死亡的第三⼤大原因
• Cause: Inherited mutation (HPC1 gene), high

androgen levels, or recurrent prostatitis
病因:遗传性突变(HPC1基因)，雄
激素⽔水平⾼高，或复发性前列列腺炎
• Signs and symptoms: Hard nodules (detected
by digital rectal examination), obstruction of
urethra, reduced urine stream, blood in
semen 体征和症状:硬结节(直肠指检)、尿尿
道梗阻、尿尿流减少、精液中有⾎血
• Diagnostic tests: Serum prostate specific

antigen (screening); ultrasound and biopsy
(confirmation)
诊断试验:⾎血清前列列腺特异性抗原(筛查);超声及活检(确认)
• Treatment: Surgery, radiotherapy, or

治疗:⼿手术、放疗或抗睾酮治疗
anti-testosterone therapy
17
http://www.dana-farber.org/Health-Library/Prostate-Cancer-Treatment-(PDQ%C2%AE).aspx
Testicular cancer 睪丸癌
• The most common solid tumor in young

men (15-35 years old)
青年年男性(15-35岁)最常⻅见的实体瘤
• Causes: Mutation in chromosome 12,

cryptorchidism
病因:12号染⾊色体突变，隐睾
• Signs and symptoms: Enlarged testes,

pain in lower abdomen
体征和症状:睾丸增⼤大，下腹疼痛
• Diagnostic tests: Ultrasound, CT scans,

tumor markers (e.g. alpha-fetoprotein
and hCG)
诊断测试:超声、CT扫描、肿瘤标志物(如甲胎蛋⽩白、hCG)
• Treatment: Surgery (orchiectomy),

radiation therapy, or chemotherapy
治疗:⼿手术(睾丸切除术)、放疗或化疗
http://simple-health-secrets.com/wp-content/uploads/2012/10/Testicle-Cancer-5.jpg 18
http://www.laparoboticsurgery.com/patient-information/disease-states/testicular-cancer-overview/
Female reproductive system
Overview of the female reproductive system
• Ovaries 卵卵巢
- Production of eggs (oocytes)
卵卵⼦子的产⽣生(卵卵⺟母细胞)
• Oviducts (Fallopian tube) 输卵卵管(输卵卵管)

- Passage of eggs and fertilization
卵卵⼦子通过和受精
• Uterus ⼦子宮
- Placentation and fetal development
胎盘和胎⼉儿发育
外阴(阴道和外⽣生殖器)
• Vulva (vagina and external genitalia)
- Passage of sperm during sexual
intercourse 性交时精⼦子的通过
• Mammary glands 乳腺
- Production of milk
乳汁的產⽣生
20
Raven et al. Biology, 9th Ed., McGraw-Hill
Ovaries 卵卵巢
• Female gonads which produce sex

hormones and gametes (oocytes)
产⽣生性激素和配⼦子(卵卵⺟母细胞)的雌性⽣生殖腺
• Structures:
1. Germinal epithelium ⽣生殖上⽪皮
2. Ovarian cortex: Ovarian follicles
and connective tissue 卵卵巢⽪皮质:卵卵泡
和结缔组织
3. Ovarian medulla: Blood vessels,
卵卵巢髓质:⾎血管、
lymph vessels, and nerves淋淋巴管和神经
4. Ovarian follicles: 卵卵泡
- 1o and 2o follicles  Egg
maturation and estrogen
1o + 2o 卵卵泡，卵卵⼦子成
production 熟+雌性激素的產⽣生
- Mature follicles  Mature
ooctyes 成熟的卵卵泡----- 成熟的卵卵⺟母細胞
- Corpus luteum  Progesterone
and estrogen 黃體----孕激素----雌激素 21
http://www.tarleton.edu/Departments/anatomy/ovary.html
Oogenesis 卵卵⼦子發⽣生
• Stimulated by FSH and LH from anterior
pituitary 由垂体前叶的FSH和LH刺刺激
• Meiosis I (after puberty): 减数分裂I(青春期后):

Oogonium (2n) 卵卵原細胞（2n）
 Primary ooctye (2n) 初級卵卵⺟母細胞
 Secondary oocyte (n) + First polar body
(n) 次級卵卵⺟母細胞（n) + 第⼀一極體（n)
減數分裂 II (在排卵卵前）
• Meiosis II (just before ovulation):
Secondary oocyte (n) in a mature follicle
begins meiosis II  Ovulation
成熟卵卵泡中的次级卵卵⺟母细胞(n)
开始减数分裂II ——排卵卵
• Completion of meiosis II (if fertilization
occurs): 减数分裂的完成(如受精)
发⽣生):
Ovulated secondary oocyte (n)
 Ovum (n) + Second polar body (n) 次级卵卵⺟母细胞(n)
—— 卵卵⼦子(n) +第⼆二极体(n) 22
Follicle development and estrogen synthesis
卵卵泡发育和雌激素合成
• Primordial, primary, and secondary

follicles  Primary oocytes (2n)
原始卵卵泡，初级卵卵泡和次级卵卵泡-----初级卵卵⺟母细胞(2 n)
• Mature (Graafian) follicles  Secondary

oocytes (n)
成熟(Graafian)卵卵泡-次级卵卵⺟母细胞(n)
• Structures of a mature follicle:

1. Theca cells 卵卵泡膜细胞产⽣生睾酮(黄体⽣生成素刺刺激)
- Produce testosterone (stimulated by LH
2. Granulosa cells 颗粒细胞
- Convert testosterone into estrogen
(stimulated by FSH) 将睾酮转化为雌激素(FSH刺刺激)
3. Antrum (fluid-filled) 腔 (充满液体)
4. Corona radiata and zona pellucida
- Protect oocytes 放射冠和透明带
颗粒细胞将雄激素
保護卵卵⺟母細胞卵卵泡膜細胞合成雄激素转化为雌激素
Vander A., Sherman, J and Luciano, D. (2010) Human 23

http://faculty.southwest.tn.edu/rburkett/A&P2_reproductive_system_lab.htm Physiology, 12th ed. (McGraw Hill)
输卵卵管(⼦子宮管)
Oviducts (Uterine tubes)
• Provide a route for sperm to reach an

egg and transport the fertilized egg to
the uterus 为精⼦子到达卵卵⼦子并将受精卵卵
运送⾄至⼦子宫提供⼀一条路路径
• Contractions of uterine muscle and

cilia on epithelial cells ⼦子宫肌⾁肉和纤⽑毛对
上⽪皮细胞的收缩
 Move fertilized eggs to uterus
将受精卵卵移⾄至⼦子宫
• Non-ciliated peg cells have microvilli

to secrete nutrients for the egg
⽆无纤⽑毛的聚⼄乙⼆二醇细胞有微绒⽑毛为
卵卵细胞分泌泌营养物质
24
Uterus ⼦子宫
⽤用于植入和胎盘的⼀一个厚的肌⾁肉腔
• A thick muscular chamber for implantation and placentation
• Uterine wall has 3 layers: perimetrium (outer), myometrium (middle),
and endometrium (inner) ⼦子宫壁分三层:⼦子宫周(外)、⼦子宫肌层(中)、
和⼦子宫内膜(内部)
• Endometrium is highly vascular (blood vessels and glands)
⼦子宫内膜是⾼高⾎血管性的(⾎血管和腺体)
 Optimal for implantation
最优的植入
25
http://biology-forums.com/index.php?action=gallery;sa=view;id=8250
Female reproductive cycles:
Ovarian and menstrual cycles
女性⽣生殖周期:卵卵巢和⽉月经周期
26
Summary of ovarian and menstrual cycles
27
女性⽣生殖系统紊乱
Disorders of the female

reproductive system
- Menstrual disorders ⽉月经紊乱
- Infection 感染
- Tumors
肿瘤
28
⽉月經紊乱: ⽉月經不調/閉經뛥
Menstrual disorder: Amenorrhea
• Amenorrhea: Absence of menstruation 闭经:没有⽉月经
disintegration of the
endometrium
• Causes:
特納⽒氏綜合症主要:特纳综合征(性染⾊色体XO);下丘
- Primary: Turner syndrome (sex 脑或垂体的先天性缺陷;没有⼦子宫
chromosome XO); congenital defects in
hypothalamus or pituitary; absence of
uterus 沒有⼦子宮
- Secondary: Tumors in hypothalamic-
pituitary axis, stress, sudden weight
loss
继发性:下丘脑-垂体轴肿瘤，应激，体重突然下降 hypothalamic amenorrhea 下丘腦閉經
• Symptoms: Primary (menarche never

occurs); secondary (stop of
menstruation) 症状:原发(从未发⽣生⽉月经初潮);
第⼆二次(⽉月经停⽌止)
why pregnancy 期間，不來來⽉月經
• Treatment: Surgery (tumors) or

治疗:⼿手术(肿瘤)或⼼心理理治疗(压⼒力力)
psychological therapy (stress)
29
http://medeasy.me/2012/05/17/ch-11-amenorrhea/
⽉月经紊乱:经前综合症
Menstrual disorder: Premenstrual syndrome (PMS)

⽉月经前⼀一周左右
• About 1 week before menstruation
原因:未知;荷尔蒙因素? the change of
GnRH……..
• Cause: Unknown; hormonal factors?
• Signs and symptoms: Breast

tenderness, weight gain, bloating,
irritability, emotional problems,
fatigue, depression
体征和症状:乳房压痛、体重增加、腹
胀、易易怒、情绪问题、疲劳、抑郁
• Treatment: Anti-depressants
治疗:抗抑郁药
30
http://goeshealth.com/family-health/tips-to-overcome-premenstrual-syndrome.html
⽉月经失调:⼦子宫内膜异位
Menstrual disorder: Endometriosis
• Presence of endometrial tissue outside

uterus (e.g. ovaries and colon)
⼦子宫外存在⼦子宫内膜组织(如卵卵巢和结肠)
• Growing  Degenerating  Shedding and

bleeding  Inflammation and pain
⽣生⻓长-------退化-------脱落落 + 出⾎血-------发炎 + 疼痛
• Cause: Unknown; could be due to spread of

tissue through blood/lymph or
transplantation of tissue during surgery
原因:未知;可能是由于⼿手术中组
织通过⾎血液/淋淋巴扩散或组织移植
• Signs and symptoms: Painful menstruation
and intercourse progesterone and
estrogen孕激素和雌激素
症状和体征:⽉月经和性交疼痛
• Treatment: Surgery or hormonal therapy
•治疗:⼿手术或激素治疗
31
可以吃： contraceptive pills http://www.dajmd.com/endometriosis.html
感染:盆腔炎(PID)
Infection: Pelvic inflammatory disease (PID)
• Infection of reproductive tract: vagina

(vaginitis), cervix (cervicitis), uterus
(endometritis), oviduct (salpingitis), and
ovary (oophoritis)
⽣生殖道感染:阴道(阴道炎)、⼦子宫颈(宫颈炎)、⼦子宫
(⼦子宫内膜炎)、输卵卵管(输卵卵管炎)、卵卵巢(卵卵巢炎)
• Causes: Sexually transmitted diseases,
surgical instruments contaminated by
bacteria
病因:性传播疾病、被细菌污染的⼿手术器械
• Signs and symptoms: Lower abdominal

ascending infection
pain, discharge of pus from cervix, fever
体征和症状:下腹痛、宫颈脓流、发热
• Treatment: Aggressive treatment with

antibiotics (e.g. cefoxitin and
doxycycline)
治疗:抗⽣生素的积极治疗(如头孢⻄西丁和强⼒力力霉素) 32
http://www.drugs.com/health-guide/pelvic-inflammatory-disease-pid.html
Tumor: Breast cancer
香港最常⻅见的女性癌症(第三癌症杀⼿手)
• Most common female cancer in
HK (no. 3 cancer killer)
病因:BRCA-1和BRCA-2基因突变，⾼高雌激素⽔水平
• Causes: Mutation in BRCA-1 and also ovarian cancer

BRCA-2 genes, exposure to high
they effect their tumor
estrogen levels suppressor genes
why some female gain high estrogen levels?
contraceptive 避孕藥 + food：chicken
• Signs and symptoms: Hard nodule

in breast, discharge from nipple
体征和症状:乳腺硬结节，乳头溢液 preventive double
• Treatment: Surgery mastectomy
预防性乳房切除术
(mastectomy), radiotherapy,
chemotherapy
治疗:⼿手术(乳房切除)、放疗、化疗
http://www.thefrisky.com/2013-05-14/angelina-jolie-reveals-shes-had-a-double- 33
mastectomy-to-prevent-breast-cancer/ http://americanrtl.org/abortion-breast-cancer
Tumor: Cervical cancer ⼦子宫颈癌
通过巴⽒氏涂片筛查(刮除宫颈细胞)减少74%
• Reduced by 74% with Pap smear
screening (scraping of cervical cells)
HPV vaccine
• Cause: Sexually transmitted infection by

human papillomavirus (HPV)
病因:⼈人类乳头瘤病毒(HPV)性传播感染
• Signs and symptoms: Asymptomatic at

early stage; bleeding and watery
discharge at late stage 体征和症状:早期⽆无症状;晚期
出⾎血和⽔水样分泌泌物
• Treatment: Surgery combined with

radiation 治疗:⼿手术加放疗
metastasis：形容癌細胞轉移
http://english.peopledaily.com.cn/200312/30/eng20031230_131528.shtml 34
Case study: Hermaphrodite
• Caster Semenya (Women’s 800 m World Champion;

Rio Olympics 800 m gold medalist; South Africa)
• With undescended testis, high levels of testosterone,

external female genitalia but no ovaries
 Hermaphrodite 雌雄同體 = intersex
• http://www.youtube.com/watch?v=MpblUehi9Dk
• Do you think Caster Semenya should be banned from

international competitions? Why?
• What is the most appropriate way to determine our

identity as female or male?
chromosome sex： XX or XY
35
http://studysex.blogspot.hk/
Introduction to Human Diseases:
Pathology and Pathophysiology
Course code: CCST 4048
Part B (Section 1)
(Chapter 1) Altered Cellular and Tissue Biology

Lecturer:
Mr Tim Cheng
HKU SPACE Community College
Copyright 2020
https://cdn.the-scientist.com/assets/articleNo/34432/aImg/10145/cellular-rehab-l.jpg
细胞的变化和适应
Cellular Change and Adaptation
所有的疾病都是从细胞改变开始的
All forms of disease begin with alterations in
cells. 细胞及其周围环境(即细胞外基质)的损伤
导致组织和器官的损伤——器官衰竭
Injury to cells and their surrounding
environment (i.e. the extracellular matrix)
leads to tissue and organ injury  organ
failure 细胞适应是⼀一种可逆的、结构上的
或功能上的反应。它可以发⽣生在
Cellular adaptation is a reversible, structural,

or functional response. It can occur under
1. normal or physiological conditions 正常或⽣生理理条件
2. adverse or pathological conditions
不良或病理理状态
Cells can adapt to physiologic demands or
stress to maintain homeostasis.
细胞可以适应⽣生理理需求或压⼒力力，以维持体内平衡
2
https://i.ytimg.com/vi/ctdY6HfT1WE/maxresdefault.jpg
https://d1yboe6750e2cu.cloudfront.net/i/b60cd2124a4d7e8326922aa8fe3e8073e30d8d6d
Cell Regeneration 細胞再⽣生
1. ⽣生理理再⽣生
1. Physiological regeneration
• The labile and stable cells keep generating
new cells to replace the constant loss of
cells caused by day-to-day activities
Examples: 不稳定和稳定的细胞不不断产
⽣生新的细胞，以取代⽇日常活
1. Epidermis 动造成的细胞不不断流失
2. Mucosa in the GI tract
3. Blood cells
2. 修復再⽣生
2. Reparative regeneration 1. Labile cells - routinely divide and replace cells
• Induced by damage 引起的损害 that have a limited lifespan; with stem cells
不稳定的细胞——定期分裂和替换寿命有限的细胞;⽤用⼲干细胞
• The labile and stable cells undergo cell
2. Stable cells - usually have a long lifespan with
division for healing normally a low rate of division but can rapidly
不稳定和稳定的细胞进⾏行行细胞分裂愈合 divide upon demand
稳定的细胞-通常寿命⻓长，分裂率低，但可以根据需要迅速分裂
3. Permanent cells- never divide and do not have

the ability for replication even when stressed or
some cells die
永久性细胞-永远不不会分裂，没有复制的能⼒力力，即使有压⼒力力或⼀一些细胞死亡
http://www.toxicologyschools.com/Free_Toxicology_Course2/a32.htm 3
Physiological Adaptation
⽣生理理适应是为了了帮助⾝身体⽽而对外界刺刺激作出的内部系统反应
Physiological adaptations are internal systematic responses to external stimuli in order
to help the body
Examples:
1. Human teeth for mechanical digestion ⼈人类⽤用于机械消化的牙⻮齿
运动、性和⽣生⻓长激
2. Exercise, sex and growth hormones stimulate muscle growth 素刺刺激肌⾁肉⽣生⻓长
3. Bigger breast and thicker endometrium lining during pregnancy
怀孕期间乳房更更⼤大，⼦子宫内膜更更厚
https://amp.businessinsider.com/images/57628aaedd0895ac7a8b4b34-960-720.jpg 4
http://cdn.babysounds.com/wp-content/uploads/2014/11/changes-of-breast-while-pregnant.png
⾃自适应细胞变化
Adaptive Cellular Changes
萎缩(细胞变⼩小)
肥⼤大(细胞增⼤大)
增⽣生(细胞数量量增加)
化⽣生/組織變形 (⼀一种发育不良

细胞向另⼀一种细胞的 (⽆无序增⻓长)
转化)
5
https://basicmedicalkey.com/wp-content/uploads/2016/09/F000048f04-06-9781455726509.jpg
(1) Atrophy 萎縮
细胞⼤大⼩小的减少
A decrease in cellular size 包括上⽪皮细胞、神经细胞和肌⾁肉细胞
• Including epithelial, nerve and muscle cells
• The amount of endoplasmic reticulum,内质⽹网、线粒体
和微丝数量量减少
mitochondria, and microfilaments decrease.
• The mechanisms of atrophy include decreased
protein synthesis, increased protein catabolism.
萎缩的机制包括蛋⽩白质合成减少，分解代谢增加。
Causes (Etiology) 原因/病因

I. Disuse 停⽌止使⽤用
减少神经或激素刺刺激
II. Reduced neurologic or hormonal stimulations
III. Reduced/absent blood supply 减少和缺乏⾎血液供应
IV. Aging 老化
Example:
• Brain atrophy in Alzheimer’s disease
阿尔茨海海默⽒氏症患者的脑萎缩
6
http://lopasgen677s09.weebly.com/uploads/1/7/2/1/1721475/1264957.jpg
(2) Hypertrophy 肥⼤大/過度增⼤大
细胞⼤大⼩小的增加
An increase in the size of cells
• Cells increase the amounts of protein in
the plasma membrane, endoplasmic
reticulum, microfilaments, and
mitochondria 细胞增加了了质膜、内质⽹网、微
丝和线粒体中的蛋⽩白质含量量
• Common in muscle cells
常⻅见于肌⾁肉细胞
Causes:
1. Increased work demands 增加了了⼯工作要求
– Common in muscles 常⻅见于肌⾁肉
– E.g. consistent skeletal muscle
training leads to physiological
hypertrophy
例例如，持续的骨骼肌训练会导致⽣生理理肥⼤大
2. Increased hormonal stimulation

增加荷尔蒙的刺刺激
7
http://upload.wikimedia.org/wikipedia/commons/thumb/6/64/Hyperplasia_vs_Hypertrophy.svg/2000px-Hyperplasia_vs_Hypertrophy.svg.png
⼼心肌梗死慢性运动怀孕
慢性⾼高⾎血压主
动脉瓣狭窄
⼼心脏扩张 Cell death 病理理性肥⼤大⽣生理理性肥⼤大
慢性压⼒力力(如慢性⾼高⾎血压或主动脉瓣狭窄)会使⼼心肌负担过重
Cardiac muscle can be over-burdened by chronic stress (i.e. chronic hypertension or
aortic valve stenosis) 虽然⼼心壁增厚(肥厚)，但不能有效地泵⾎血
• Although heart wall is thickened (hypertrophy), it CANNOT pump blood efficiency
• Reduces the stroke volume and cardiac output (and finally blood pressure)
• “Cardiac pathological hypertrophy” ⼼心脏病理理肥⼤大减少中⻛风量量和⼼心输
出量量(最后是⾎血压)
Video: https://ed.ted.com/lessons/what-makes-muscles-grow-jeffrey-siegel
8
http://www.nature.com/nrm/journal/v7/n8/images/nrm1983-i1.jpg
(3) Hyperplasia 增⽣生
Increase in the number of cells caused by an

increased rate of cellular division
细胞分裂速度加快引起的细胞数量量的增加
Normal hyperplasia is stimulated by hormones or

the need to replace lost tissue 正常的增⽣生是由激素或需要补
充失去的组织引起的
• Common in epithelial and connective-tissue
cells 常⻅见于上⽪皮细胞和结缔组织细胞
• May occur with hypertrophy simultaneously 可能与肥⼤大同时发⽣生
• May be an early sign of cancer development
可能是癌症发展的早期迹象
Example:
Enlarged uterus 增⼤大的⼦子宫
• abnormal growth of uterus due to excessive
hormonal stimulation
由于过度的荷尔蒙刺刺激⽽而导致⼦子宫异常⽣生⻓长
http://www.beltina.org/pics/hyperplasia.jpg 9
http://physiologicalresponsestotraining.weebly.com/uploads/4/8/1/9/48193267/4563996.png?313
(4) Metaplasia 組織變形
The reversible replacement of one mature cell type by another less mature cell type
(less differentiated cell type) ⼀一种成熟细胞类型被另⼀一种不成熟细胞
类型(低分化细胞类型)可逆替换
Example:
The replacement of normal columnar ciliated epithelial cells of the bronchial
lining by stratified squamous epithelial cells 层状鳞状上⽪皮细胞替代正常⽀支⽓气管
内膜柱状纤⽑毛上⽪皮细胞
Cause: Triggered by cigarette smoking 起因:吸烟引起
• The newly formed cells do not secrete mucus or have cilia 新形成的细胞不分泌泌
• Causing loss of a vital protective mechanism 粘液，也没有纤⽑毛
导致重要的保护机制的丧失
化⽣生的上⽪皮细胞
鳞状上⽪皮上⽪皮化⽣生模型 10
http://pathol.med.stu.edu.cn/pathol/fileUpload/imageUpload/1Injury/19SquasmousMetaplasiaModel.jpg
(5) Dysplasia 發育不良
⻓长时间暴暴露于诱发性刺刺激(如前例例
吸烟)，可发⽣生发育不良和癌变
With prolonged exposure to the inducing
stimulus (i.e. cigarette smoking in the previous
case), dysplasia and cancerous transformation
can occur.
发育不良是⼀一种非典型增⽣生
Dysplasia is a atypical hyperplasia
• An abnormal change in the size, shape,
and organization of mature tissue cells.
– large nucleus 成熟组织细胞在⼤大⼩小、形状
和组织结构上的异常变化
– change in tissue structure
组织结构的改变
• It is considered an atypical rather than a
true adaptational change 这被认为是⼀一个非典型的，⽽而
不是⼀一个真正的适应性变化
• A sign of pathological change
病理理变化的迹象
11
http://2.bp.blogspot.com/-13E-P_iuHYw/URQgJHlFAwI/AAAAAAAAAZw/XNoqIuCLV1k/s1600/aCervical_dysplasia_severe.jpg
Summary
Atrophy 萎缩
Hypertrophy 肥⼤大
Hyperplasia 增⽣生
Metaplasia 化⽣生/組織變形
Dysplasia 发育不良
12
https://sites.google.com/site/pathologylecturenotes/cellular-pathology
案例例研究:宫颈上⽪皮化⽣生和发育不良
Case Study: Cervical Metaplasia and Dysplasia

宫颈发育是⼀一个动态过程。宫颈细胞对不同的激素环
境有不同的反应，容易易产⽣生适应性和非适应性反应
Cervical development is a dynamic process. The cervical cells respond to different
hormonal environment, they have adaptive and maladaptive responses easily.
ANS: It is epithelium with epithelia cells which are
labile 是由上⽪皮细胞构成的不稳定的上⽪皮细胞
1. What type of tissue can be found on the surface of the cervix?
2. How can the cellular changes be detected?
3. What types of cellular change may occur? hyperplasia and metaplasia
13
http://o.quizlet.com/XbDxGtM7GXPiFdl60dHOCA_m.png
http://almostadoctor.co.uk/sites/all/files/image/Systems/Obs%20&%20Gyn/Cervical/235x353xtransformation,P20zone.png.pagespeed.ic.UIv0zjB88s.png
可逆的損傷
(體內平衡）
有害的刺刺激輕度，短暫
严重的进步
不可逆的损伤
坏死细胞凋亡
14
Cell Injury
Most diseases begin with cell injury⼤大多数疾病始于细胞损伤

• The cell is unable to maintain homeostasis 细胞⽆无法维持内稳态
• Injured cells may 受损细胞可能
– recover (reversible injury): loss of ATP,
cellular swelling, detachment of
ribosomes 恢复(可逆损伤):ATP丢失、
细胞肿胀、核糖体脱落落
– die (irreversible injury): severe
vacuolization of mitochondria occurs
死亡(不可逆损伤):线粒体发⽣生严重空泡化
Causes of cellular injury

1. ATP depletion, resulting in mitochondrial
damage ATP耗尽，导致线粒体损伤
2. Accumulation of free radicals, causing
membrane damage ⾃自由基的积累，造成细胞膜损伤
3. Protein folding defects 蛋⽩白质折叠缺陷
4. Increased intracellular Ca2+
增加细胞内钙离⼦子
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缺氧損傷
Hypoxic Injury
缺氧损伤的初始损伤通常是缺⾎血
The initial insult in hypoxic injury is usually
ischemia
• the cessation of blood flow into vessels that
supply the cells with oxygen and nutrients
⾎血液停⽌止流入为细胞提供氧⽓气和营养物质的⾎血管
Example of hypoxic injury:

Ischemic heart disease leads to myocardial
infarction 缺⾎血性⼼心脏病导致⼼心肌梗死
⼼心肌梗死 16
https://www.danintranet.org/media/adimg/12274.jpg
中風
Ischemia
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磷脂的损失
细胞骨架的改变
激活的炎症
阻塞或停⽌止⾎血液流动 (补体、细胞因⼦子和⽩白细胞)
增加⾃自由基
脂质分解
线粒体严重空泡化
线粒体氧化
增加溶酶体酶(⽔水解酶)的释放
内质⽹网扩张
核染⾊色质凝集
超然的核糖体
⽂文字
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再灌注損傷
Reperfusion Injury
没有氧⽓气，细胞表现出缺氧损伤并肿胀
• Without oxygen, the cells display hypoxic injury and become swollen
• With reoxygenation, reperfusion injury increase 随着复氧、再灌注损伤的增加
– The formation of reactive oxygen radicals 活性氧⾃自由基的形成
– Can lead to cell death 可导致细胞死亡
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Manifestations (Signs) of Cellular Injury:
Local Inflammation 局部炎症
物理理/化学因素或病原微⽣生物引起的组织损伤
⽑毛細⾎血管擴⼤大
Exudate
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https://ib.bioninja.com.au/_Media/inflammation_med.jpeg
细胞损伤的全⾝身表现
Systemic Manifestations of Cellular Injury

Manifestation Cause
Fever Release of endogenous pyrogens (fever inducing substances: IL-1, tumor
necrosis factor α) from bacteria or macrophage 释放内⽣生致热源(热诱导物
• acute inflammatory response 质:il - 1、肿瘤坏死因⼦子α)
从细菌或巨噬细胞
Increased heart Increase in metabolic process resulting in fever •急性炎症反应
rate
Increase in Increase in total number of WBCs because of infection; 因感染⽽而增加的⽩白细胞总数;
leukocytes Normal is 5000-9000 /mm3
(leukocytosis) • increase is directly related to severity of infection 增加与感染的严重程度直接相关
Pain Various mechanisms, such as release of bradykinins, obstruction, pressure
細胞酶的存在各种机制，如释放缓激肽，阻塞，压⼒力力
Presence of Release of enzymes from cells in extracellular fluid
cellular enzyme 从细胞外液中释放酶
乳酸脱氢酶(LDH) Lactate • Release from RBCs, liver, kidney, skeletal muscle

dehydrogenase
(LDH)
Aspartate • Release from heart, liver, skeletal muscle, kidney, pancreas
aminotransferase
(AST)
天冬氨酸转氨酶(AST）
22
天冬氨酸转氨酶(全⾝身性表现:1)发热
Systemic Manifestation: (1) Fever

体温设定值由下丘脑(体温调节中⼼心)调节
• Body temp. set point is regulated by the hypothalamus
(Thermoregulatory center) 当⾝身体受到感染/受伤时，体温设定值会增加
– Body temperature set point increases when the
body gets infected/injured 增加产热(如发抖)和减少热损失
(如⾎血管收缩、蜷缩⾝身体
– Increase heat production (i.e. shivering) and reduce
heat loss (i.e. vasoconstriction, curl up body)
– More heat in the body and thus increases body
temperature 体内的热量量增加，从⽽而提⾼高体温
由于体温调节控制系统的设定值⾼高于体温，⽪皮
肤⾎血管床的颤抖和⾎血管收缩被激活。
由于设置点低于体温，⽪皮肤⾎血管床的出汗和
⾎血管舒张被激活
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Inflammation: Fever
发热物质⽩白介素-1 (IL-1)从受伤部位释放到⾎血流中
Fever
• fever-producing substance interleukin-1 (IL-1) is released from the site of injury
into the bloodstream
1: 吞噬细胞分泌泌的IL-1通过⾎血液进入下丘脑
2: 下丘脑分泌泌前列列腺素，它能重置下丘脑的恒温器
3: 神经冲动会导致颤抖、代谢率升⾼高、出汗抑制和⾎血管收缩
4: 这些会将体温升⾼高到下丘脑恒温器设定的温度点
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(2) Leukocytosis ⽩白细胞增多
\最初，炎症反应是对任何细胞或组织损伤的局部反应⽩白细胞增多提⽰示⾝身体可能存在⼴广泛的组织损伤
Originally, inflammatory response is a local Leukocytosis indicates that there may be extensive
response to any cell or tissue injury tissue damage in the body
当出现⼴广泛的炎症时，可能出现全⾝身症状，
包括发热和⽩白细胞增多(⽩白细胞总数增加)
With extensive inflammation, systemic
signs may present including fever and
leukocytosis (an increase in the total
number of WBCs) 更更多的⽩白细胞抵达现场，清除
感染源和碎片
• More white blood cells arrive to the site
to remove infectious agents and debris
• limits the extent of injury, partially or
fully eliminates the cause of injury, and
initiates repair and regeneration of Immature WBC are released from bone
marrow. It is a rapid response (within hours):
damaged tissue
限制损伤的程度，部分或完全消除损伤的 A “shift to the left” on blood film
原因，并启动受损组织的修复和再⽣生未成熟的⽩白细胞从骨髓中释放出来。这
是⼀一个快速的反应(在⼏几个⼩小时内):在⾎血
液胶片上“向左移动”
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atment_slideshow/webmd_rm_photo_of_cml_affecting_white_blood_cells.jpg
(3) Aspartate Aminotransferase (AST)
AST (SGOT)检测是⼀一种⾎血液检测，是肝脏的
⼀一部分。它测量量两种肝/⼼心酶(转氨酶)中的⼀一种
The AST (SGOT) test is a blood test that’s part of a liver profile. It measures one of two
liver/cardiac enzymes (transaminase)
这种酶现在通常被称为天
• This enzyme is now usually called Aspartate aminotransferase (AST) 冬氨酸氨基转移酶(AST)
• The AST test evaluates how much of the liver enzyme is in the blood
• Video: https://www.youtube.com/watch?v=wA2IywSlBPc AST测试评估⾎血液中有多少肝酶
上升取决于受伤细胞的数量量
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Irreversible Injury: Cell Death
壞死凋亡
Cell death has been classified as necrosis and apoptosis
https://servier.com/wp-content/uploads/2018/08/apoptosis.png
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坏死
Necrosis
当组织暴暴露在
Necrosis occurs when the tissue is exposed to
1. ischemia 缺⾎血
2. hypoxia 缺氧
3. toxic substances 有毒物质
感染(细菌或病毒感染)
4. infection (bacterial or viral infection)
它通常是病态的
It is always pathological and characterized by
• rapid loss of the plasma membrane structure 质膜结构迅速丧失
• organelle swelling 细胞器肿胀
• mitochondrial dysfunction 线粒体功能障碍
• massive cell damage ⼤大量量细胞损伤
• cells swell and rupture 细胞膨胀和破裂
• cellular contents release that leads to inflammatory response 细胞内容物释放导致炎症反应
• organelles are no longer functional 细胞器不再起作⽤用

• irreversible 不可逆
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Necrosis 坏死
不同类型的坏死发⽣生在不同的组织中
Different types of necrosis occur in different tissues 1: 凝固性坏死:⼼心肌、肝脏和肾脏的坏死
1. Coagulative necrosis: necrosis of heart muscle, liver and kidney
2. Liquefactive necrosis: Cell death in brain2: 液化性坏死:脑内细胞死亡
3: ⼲干酪样坏死:结核
3. Caseous necrosis: Infection with mycobacterium tuberculosis (lungs) 分枝杆菌感染(肺)
4. Fat necrosis: Cell death in liver (in fatty liver) and pancreas 4: 脂肪坏死:肝(脂肪
肝)和胰腺的细胞死
5. Gangrene: Necrosis of appendages, usually in limbs 亡
坏疽:附肢的坏死，通常在四肢
凝固性坏死，通常由缺⾎血
或梗死引起。死亡组织的
结构⾄至少要保存⼏几天。
Coagulative necrosis typically caused by Liquefactive necrosis in brain tissue is a
ischemia or infarction. The architecture of dead transformation of the tissue into a liquid
tissue is preserved for at least a couple of days. viscous mass.
脑组织液化性坏死是脑组织向液体黏性团块的转化
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⽪皮膚的傷⼝口癒合뺭
Cutaneous (Skin) Wound Healing
⽂文字
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瘢痕和⾁肉芽组织湁
Scar and Granulation Tissue
当结缔组织蛋⽩白如胶原蛋⽩白过量量时，就会产⽣生疤痕
Scars occur when there is overproduction of connective tissue
proteins such as collagen 防⽌止伤⼝口部位形成正常的上⽪皮组织
• prevent the formation of normal epithelial tissue over the
wound site 形成⾁肉芽组织(潮湿和⾼高⾎血管性)
• form the granulation (moist and highly vascular) tissue
• if the wound is too wide or the granulation tissue grows too
extensively, the re-epithelialization cannot occurs
如果伤⼝口太宽或⾁肉芽组织⽣生⻓长
– This results in a scar 太⼴广，就不能发⽣生再上⽪皮化
这会造成疤痕
The granulation tissue grows into the gap of the wound from the
nearby connective tissue ⾁肉芽组织从附近的结缔组织⽣生⻓长到伤⼝口的缝隙中
• Nonfunctional 非功能
• Fibrosis (i.e. skin and liver)
纤维化(即⽪皮肤和肝脏)
Granulation tissue
⾁肉芽組織
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細胞凋亡
Apoptosis
被称为“程序性细胞死亡”
Known as “Programmed cell death” ⼀一种独特的亚致死损伤
• A distinct type of sub-lethal injury
• A process of selective cellular self-⼀一个选择性细胞⾃自我
毁灭的过程，发⽣生在
destruction that occurs in both 正常和病理理组织的变
normal and pathologic tissue changes 化
• An active (ATP-dependent) cell death
process in an individual cell 单个细胞中活跃的(atp依赖的)
细胞死亡过程单个细胞中活跃
• Without inflammation 的(atp依赖的)细胞死亡过程
没有炎症
Normal occurrence in the body to control

cell number 正常发⽣生在体内，以控制细胞数量量
• also a process to eliminate abnormal
or cancer cells
也是⼀一个消除异常或癌细胞的过程
1:细胞被破坏、受到压⼒力力或被⾝身体的罪恶触发，开始凋亡。
2:细胞开始收缩和形成⽓气泡。蛋⽩白质被激活来分解细胞成分。
3:酶分解细胞核，细胞发出信号吸引噬菌体。
4:细胞分裂成⼏几⼩小块，含有细胞成分和被破坏的细胞核。
5:巨噬细胞识别细胞部分并将其从体内清除。 32
http://static.ddmcdn.com/gif/apoptosis-diagram.gif
Pro-apoptotic proteins (i.e. p53) are
released from mitochondria.
They activate a protease
(called caspase) to trigger apoptosis
促凋亡蛋⽩白(即p53)从线粒体
中释放。
它们激活⼀一种蛋⽩白酶(称为
caspase)来触发细胞凋亡
①
Signals or
p53
Stressors DNA
e.g. damage
•Radiation
•Toxins
•Free radicals
33
细胞凋亡和肿瘤
Apoptosis and Tumor

抗凋亡失败导致肿瘤的发⽣生
Resisting/failure in apoptosis lead to tumor development
• The body cannot control the cell number and thus cells continue to divide
⾝身体⽆无法控制细胞数量量，因此细胞继续分裂
傳播惡惡性腫瘤
良性腫瘤
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nutrients
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http://www.charite.de/klinphysio/images/grafik/necrosis_apoptosis.gif
Small projections (blebs) Small
form; the structure of the projections ⼩小突起(⽓气泡)形成
nucleus change. (blebs) form.
⼩小突起(⽓气泡)形成;原⼦子核的结构改变了了
The nucleus begins to

The projections fuse break apart, and the
and become larger; no DNA breaks into 细胞核开始分裂，
DNA分裂成⼩小块。
organelles are located small pieces. The 细胞器也位于⽓气泡中
in the projections. organelles are also
投影融合并变⼤大;没有细胞器位于预测 located in the blebs.
The cell membrane ruptures The cell breaks into

and releases the cell’s several apoptotic bodies;
content; the organelles are the organelles are still
not functional. functional.
细胞分裂为数个凋亡⼩小体;细胞器仍然有功能
细胞膜破裂并释放细胞内
容物;细胞器没有功能壞死細胞凋亡
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肿瘤(肿瘤)
Neoplasm (Tumor)
Any abnormal tissue growth that results in a benign
(harmless) or malignant (likely to result in death if not
treated) tumor/ tumour
任何导致良性(⽆无害)或恶性(如果不治疗可
能导致死亡)肿瘤/肿瘤的异常组织⽣生⻓长
• Less nutrients to normal cells 对正常细胞的营养更更少
• Expanding mass (tumor) creates pressure on

surrounding structures
膨胀的肿块(肿瘤)对周围的结构造成压⼒力力
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Neoplasm 腫瘤
invertible
肿瘤是⼀一种异常的组织块，当细胞分裂超过
正常⽔水平时就会导致肿瘤(抵抗细胞凋亡)
Tumor is an abnormal mass of tissue
that results when cells divide more
than they should (resist apoptosis)
–some tumors may even present at
birth (congenital tumors)
有些肿瘤甚⾄至在出⽣生时就存在(先天性肿瘤)
1.Benign tumor (non- cancerous) 良性肿瘤(非癌性)
2.Malignant tumor (cancerous)
恶性肿瘤(癌)
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良性肿瘤(非恶性)
Benign Tumor (Non- cancerous)
Benign Tumor 由成熟(分化)细胞组成

• Consists of mature (differentiated) cells
• Often encapsulated (with capsule
surrounding the tumor) 常被包裹(肿瘤周围有包膜)
• Does not spread 不扩散
良性肿瘤:不那么严重
Benign tumor: less serious
–Normally NOT life-threatening 通常不会危及⽣生命
• Unless the tumor affects key organs
(i.e. brain) 除非肿瘤影响关键器官(如⼤大脑)
• Tissue injury by adding pressure on the
adjacent structures such as blood
vessels and nervous tissues
通过增加对邻近结构(如⾎血管和神经
组织)的压⼒力力⽽而造成的组织损伤
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恶性肿瘤
Malignant Tumor
Cancer 由未分化的、⽆无功能的、未成熟的细胞组成
• Made up of undifferentiated, nonfunctional,
immature cells
• Do not appear organized 看起来没有条理理
• Life-threatening
有⽣生命危险
Characteristics
1.Altered cell shape 改变细胞形状
2.Uncontrolled cell growth 不受控制的细胞⽣生⻓长
3.Easily metastasize/spread (break away to
spread to other organs and tissue)容易易转移/扩散(扩散到
其他器官和组织)
– Loss of cell junctions (cells may detach
from original site) 细胞连接缺失(细胞可
能从原位点脱落落)
– Leads to tissue destruction 导致组织破坏
– Easily to spread into surrounding tissue
容易易扩散到周围组织
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惡惡性腫瘤
Malignant Tumor
肿瘤细胞不断分裂，体积增⼤大
Tumor cells keep dividing and larger in size
 failure in apoptosis 失败在细胞凋亡
 unable to be removed by immune cells ⽆无法被免疫细胞移除
 Invasion or metastasis (spreads to other regions)
侵袭或转移(向其他地区蔓延)
http://www.cancer.gov/PublishedContent/Images/images/targetedtherapies/page3_clip_image034.jpg
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http://www.edinformatics.com/biotechnology/180px-Normal_cancer_cell_division_from_NIH.png
Malignant Tumor
癌细胞失去了了其表⾯面的分⼦子，
这些分⼦子使细胞处于正确的位
置。他们与邻居疏远了了
http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@ca
h/@gen/documents/image/crukmig_1000img-12351.jpg
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http://www.women-health-info.com/images/Pap-smear-1.jpg
Growth of Malignant Tumor
恶性细胞继续潜⽔水
Malignant cells keep diving
•Healthy cells are deprived of blood and
nutrients 健康细胞被剥夺了了⾎血液和营养
•Necrosis 坏死
•Bleeding, chronic inflammation and
infection 出⾎血、慢性炎症和感染
Malignant tumor (cancer cells)

•secretes growth factors that stimulate
angiogenesis 分泌泌刺刺激⾎血管⽣生成的⽣生⻓长因⼦子
– Develop more blood capillaries
产⽣生更更多的⽑毛细⾎血管
– Increase the uptake of nutrients 良性肿瘤细胞只能在局部⽣生
(“trap” nutrients), preventing the ⻓长，不能通过侵袭或转移扩散
normal tissues from repairing
增加营养素的吸收(“陷阱”营养素)，使正常组织⽆无法修复恶性细胞侵犯邻近组织，进入⾎血
管，并转移到不同的部位
43
http://www.cancer.gov/cancertopics/understandingcancer/cancer/AllPages
Spread of Malignant Tumor
癌细胞可以通过两种⽅方式在体内扩散
Cancer cells are capable of spreading throughout the body by two ways:
1.Invasion 入侵
• Cancer cells directly migrate and penetrate into neighboring tissues
癌细胞直接迁移并渗透到邻近组织
2.Metastasis 转移
• Cancer cells penetrate into the lymphatic and blood vessels, and then
circulate through the blood, and finally invade normal tissues elsewhere in
the body 癌细胞穿透淋淋巴和⾎血管，然后在⾎血液中循环，最后侵入⾝身体其他正常组织
其他的肿瘤细胞则会在原位(即肿瘤部位)停留留很⻓长时间
Others tumors cells remain in situ (means on the site) for a long time
•A pre-invasive stage of cancer that may persist for months or years
可能持续数⽉月或数年年的癌症的侵入前阶段 Metastasis
44
science.education.nih.gov http://www.cancer.gov/cancertopics/understandingcancer/cancer/AllPages
恶性肿瘤----转移
Malignant tumor- Metastasis

Tumors cells spread by invasion or metastasis can cause
systemic signs 通过侵袭或转移转移的肿瘤细胞可引起全⾝身症状
•Bleeding 出⾎血
肿瘤细胞可能会侵蚀⾎血管
• Tumor cells may erode the blood vessels
贫⾎血(⾎血液/⾎血细胞不⾜足)
•Anemia (insufficient blood/blood cells)
 Chronic bleeding 慢性出⾎血
 Bone marrow depression due to therapy
治疗引起的骨髓抑制
•Infection (e.g. pneumonia) 感染(如肺炎)

 Immune system is less effective 免疫系统就没那么有效了了
体重减轻(严重的组织损耗)和疲劳
•Weight loss (severe tissue wasting) and fatigue
Local Effects by Tumor(s)
 Breakdown of tissue 肿瘤的局部效应 1.Pain
分解的组织 1.疼痛 2.Tissue necrosis and ulceration
2.组织坏死和溃疡
45
http://en.wikipedia.org/wiki/Metastasis
Diagnostic Test
早期癌症可能没有任何症状在感到疼痛或注意到乳
Early cancer may not have any symptoms.. 房肿块、异常出⾎血或分
泌泌物等变化之前
• Before feeling pain or when they notice
changes like a lump in the breast or unusual Positive result:
bleeding or discharge with cancer cells (Be diagnosed)
• Screening methods are designed to check for Negative result:
cancer in people with no symptoms NO cancer cells, no findings, normal result
筛查的⽬目的是检查没有
症状的⼈人是否患有癌症
Detecting cancer cells as earlier as possible can
increase the survival rate and efficacy of the
treatment  rely on diagnostic tests
尽早发现癌细胞可以提⾼高⽣生存率和治疗效果——依赖于诊断测试。
诊断测试通常不是100%可靠的
A diagnostic test is not usually 100 % reliable
• False-negative: There is a cancer but the
result is appear to be normal 假阴性:有癌症，但结果似乎是正常的
• False-positive: NO cancer but the result is
appear to be abnormal
假阳性:没有癌症，但结果似乎是不正常的
http://i01.i.aliimg.com/img/pb/046/136/482/482136046_180.jpg 46
Biopsy 活組織檢查
当初步症状出现时，巴⽒氏试验、乳房x光检查、PSA检查、
FOBT或结肠镜检查提⽰示可能存在癌症……组织学和细胞学检查
When preliminary symptoms, Pap test,

mammogram, PSA test, FOBT, or
colonoscopy indicate the possible existence
of cancer……histologic and cytological exam
Biopsy is the surgical removal of a small

piece of tissue for microscopic examination
(For leukemia, use blood sample)
look at the affected tissue sample under the
microscope to confirm the presence of
cancer
活检是⼿手术切除⼀一⼩小块组织进⾏行行显微镜检查(对于⽩白⾎血病，使⽤用⾎血样)
在显微镜下查看受影响的组织样本以确认是否存在
47
http://www.cancer.gov/PublishedContent/Images/images/documents/4167b7ca-7e27-4eec-9855-640637dde5dc/cancer17.jpg
totally having 5 stages： stage 0 ——stage 4
Classification process
Stages of Cancer
•Provides a basis for treatment and predicting 为治疗提供依据，预测可能的治疗结果(预后)
the likely outcome of treatment (prognosis) Examples of Staging- Breast Cancer
Staging systems are based on the

Stage (1): Size of the primary tumor (T)
原发肿瘤的⼤大⼩小(T)
Stages (2) and (3):
•Cancer cells are found at regional lymph
nodes (N) 在区域淋淋巴结(N)发现癌细胞
Stage (4): Spread

•invasion or metastasis (M)
侵袭或转移(M)
Breast Cancer
Stage 1 T1 N0 M0
Stage 2 T0-T2 N1 M0
Stage 3 T3 N1 or N2 M0
Stage 4 T4 N3 M1
48
http://www.npc.nhs.uk/therapeutics/other/breast_cancer/resources/cs2_breast_cancer/images/pic001.jpg
For Your Information Only
• Slide 50-56 will NOT be included in the test
and exam
49
⼦子宫颈癌(浸润性癌)
Cervical Cancer (Invasive Carcinoma)
Stage 4
Widespread
Stage 0
invasion
Carcinoma in situ
(non-invasive) ⽂文字
Stage 1 Stage 2-3

2.Cervix-invasive carcinoma 3. Vagina involved
(broken basement membrane)
drugs.com 50
vagi-wave.co.uk
病因
Etiology
Carcinogenesis ⽂文字正常细胞转化为恶性细胞的过程(癌症)
•The process by which normal cells are transformed into malignant cells (cancer)
•Based on the presences of carcinogens (radiation, cigarettes, hormones)
基于致癌物质(辐射、香烟、激素)的存在
1. DNA不可逆突变遗传变化(致
1. Irreversible mutation of DNA 癌基因因素)
•Genetic change (oncogene factor)
•Aging and weakened immune system
•Radiation: sun
The normal cell becomes mutant cell, possible intervention by DNA (repair genes). If fail to be
intervened, cause proliferation of initiated cells
正常细胞变为突变细胞，可能受到DNA(修复基因)的⼲干预。若若未被⼲干预，则导致被启动的细胞增殖
2. Repeated exposure to carcinogens (virus, cigarettes): additional risk ⽂文字

The mutant cell membrane changes, possible immune surveillance and destruction of mutant cell
⽂文字
3. Additional changes to DNA and cell structure by promoters including ⽂文字

•Hormones
•Food additives ⽂文字
•Industrial factors ⽂文字
51
http://www.scienceclarified.com/photos/carcinogen-3040.jpg
http://www.thegreengirls.com/wp-content/uploads/Carcinogen.jpg
Cervical Cancer Screening
•Pap test (or Pap smear) allows early detection of cancer of the cervix
•a sample of cells from the cervix and upper vagina
Breast Cancer Screening

•using X-ray imaging (mammogram)
•detect the possible presence of an abnormal tissue mass
Prostate and Ovarian Cancer Screening

•Blood tests to find out tumor markers (substances, enzymes, antigens or
hormones produced by some malignant cells and circulating in the blood)
Examples:
•Prostate specific antigen (PSA) for prostate cancer
•Human chorionic gonadotropin (hCG) for testicular cancer
•CA125 for ovarian cancer
Colon Cancer Screening
•a fecal occult blood test (FOBT) detects invisible amounts of blood in the
feces
•specimen is smeared on a chemically treated card
•Carcinoembryonic antigen (CEA) for colon cancer
•other options include sigmoidoscopy and colonoscopy
52
http://www.cancer.gov/cancertopics/understandingcancer/cancer/AllPages
Risk Factors (Increase a person’s chance for getting the disease)
Risk Factors Example

Genetic factors: Breast cancer: high family incidence
Oncogenes that regulate cell growth Retinoblastoma: inherited
Switched off  Switch on in a sudden Leukemia: chromosomal abnormalities
Viruses: Hepatic cancer: hepatitis virus
Oncogenic viruses alter host cell DNA Cervical cancer: Papilloma virus(HPV) or
herpes simplex II
Kaposi’s sarcoma: HIV
Radiation: Skin Cancer: sun exposure

Ultraviolet rays, x-rays and radioactive chemicals Leukemia: radiation exposure
cause cumulative chromosomal damage in cells
Chemicals: Lung cancer: lead, nickel

Exposure to both natural and synthetic products in Leukemia: solvents (e.g., benzene)
excess may be hazardous; Bladder cancer: some dyes and rubber
The effects of carcinogenic agents depend on the
amount and duration of exposure
53
Risk Factors
Risk Factors Example
Biological factors: Colon cancer
Chronic irritation and inflammation with increased Oral cancer
mitosis
Age: increasing Many cancers are more common in older
persons
Diet: Colon cancer: high-fat diet
Natural substances, additives, or Gastric cancer: smoked foods
processing/cooking methods
Hormones Endometrial cancer: estrogen
54
Treatments
May involve any or all of surgery, radiation, and
chemotherapy
•A cancer is considered cured after 5 years without
recurrence
Radiation therapy may be provided by external
sources such as a cobalt machine or by internal
implants of material such as radioactive radium
Chemotherapy frequently consists of a specific

combination of drugs administered (often
intravenously) at intervals over a period of time
Adverse effects of chemotherapy and radiotherapy

include
•Bone marrow depression causing anemia
•Epithelial tissue damage causing mucosal ulceration
and hair loss
•Nausea and vomiting We are looking for new treatments
 Drug development and gene therapy…..
55
http://www.treanda.com/images/charts/Patients/NP/np3.0_c.png
http://topnews.ae/images/chemotherapy_0.jpg
56
http://www.cancer-fund.org/tc/cancer_news_211.html
END
57
发育不良-由于慢性压⼒力力(如刺刺
激/感染)⽽而导致⼤大⼩小和形状的
改变和细胞核增⼤大 Case Study
Dysplasia – vary in size and shape and large nuclei
result from chronic stress (i.e. irritation/infection)
–A precancerous state 癌前状态
–Detection of dysplasia is the routine screening test
• Pap smear (Papanicolaou test on cervical cells)
异型增⽣生的检测是常规的筛查试验
•巴⽒氏涂片(宫颈细胞巴⽒氏试验)
http://www.drugs.com/health-guide/images/205491.jpg 58
http://anu4bindu.files.wordpress.com/2013/04/17116.jpg
Advanced Physiology and Pathophysiology
CCST 4024
Part B (Section 1)
(Chapter 2) Fluid and Electrolyte Imbalances
Lecturer:
Mr Tim Cheng
HKU SPACE Community College
Copyright 2020
Functions of Water
http://aquanewsghana.com/wp-content/uploads/2017/03/fifth-function-of-water.jpg
Total Body Water
https://ars.els-cdn.com/content/image/3-s2.0-B9781416032069100060-gr1.jpg?_ 2
Body Fluid (~40L) and Fluid Balance
体液(~40 L)分布于细胞内间隙和细胞外间隙之间
Body fluid (~40 L) is distributed between the intracellular
space and extracellular space
cytosol 胞内液:胞质溶胶 Sources and Losses of Water

Intracellular fluid: cytosol
Extracellular fluid includes
• Intravascular fluid (IVF): plasmaplasma ⾎血管内流体:⾎血漿
• Interstitial fluid (ISF): tissue

tissue fluid 间质液:组织液
• Cerebrospinal fluid (CSF): fills and surrounds the brain
brain
and the spinal cord 脑脊液(CSF):充满并包围⼤大脑和脊髓
• Fluids in cavities (i.e. synovial fluid) 腔内液体(即滑膜液)
由于年年龄、性别和脂肪含量量的不同，每个⼈人体内的总含⽔水量量也不同
Total body water content varies among individuals
because of ageage , gender
gender and fat
fat content
• More in infants (70% of body weight) and less in the
elderly people (45% of body weight) 婴⼉儿较多(占体重的70%)，
老年年⼈人较少(占体重的45%)
• Water content of men: ~ 60% of body weight, of
female: ~ 50% of body weight 男性含⽔水量量:约占体重的60%，
女性:约占体重的50%
• Obese individuals have lower water content 3
肥胖者体内⽔水分含量量较低
Chapter Outline
Part 1: Basic Chemical Knowledge: Osmolarity
Part 2: Fluid Excess: Edema
Part 3: Fluid Deficit: Dehydration
Part 4: Over-hydration: Hyponatremia (sodium imbalance)
4
Solutes
⾎血浆分解营养物质、⽓气体、离⼦子和代谢废物
Plasma dissolves nutrients, gases, ions and

metabolic wastes.
⾎血漿滲透性
Plasma osmolarity: 溶液的总溶质浓度
Total solute concentration of a solution
• It shows the number of particles of
solute per liter of solvent (water)它显⽰示了了每升溶剂(⽔水)
中溶质粒⼦子的数量量
• It indicates the body's electrolyte-
water balance 它表明⾝身体的电解质-⽔水平衡
• Solutes include Na+, K+, urea and
glucose etc. 溶质包括Na+、K+、尿尿素、葡萄糖等
• The higher the solution osmolarity, the
lower the water concentration 溶液的渗透压越⾼高，
⽔水的浓度越低
• Plasma osmolality of a normal person
is 280-300 milliosmoles/kg (mOsm/kg)
正常⼈人⾎血浆渗透压为280-300毫摩尔/千克(mOsm/kg)
http://images.tutorvista.com/cms/images/101/main-electrolytes-in-body-fluid.png
5
http://fblt.cz/wp-content/uploads/2013/12/Kapitola-07-06-ENG-01.jpg
Part 1
BASIC CHEMICAL KNOWLEDGE
6
http://mathbench.umd.edu/modules/cell-processes_osmosis/finalgraphics/triplesolution.jpg
Osmolarity
溶液中溶质越多，渗透压就越⼤大
The more the solutes in a solution, the greater the osmolarity.
Osmosis can occur between cytosol and extracellular fluid 胞浆和胞外液之间可发⽣生渗透作⽤用
• Water moves across a semi-permeable membrane from an area of low osmolarity to
an area of higher osmolarity  leads to a net fluid flow 细胞(即红细胞)在⾼高渗溶液中
⽔水通过半透膜，从低渗透压的区域移动到⾼高渗透压的区域，导致净流体流动 (即⾼高钠⾎血症、⾼高⾎血糖)
1. Cells (i.e. RBCs) in hypertonic solution (i.e. hypernatremia, hyperglycemia);

hyperglycemia
• water moves out and cells shrink shrink ⽔水分流失，细胞萎缩
细胞在低渗溶液中
2. Cells in hypotonic solution (i.e. over-hydrated, hyponatremia); (即过⽔水、低钠⾎血症)
• water moves in, creating outward pressure; ⽔水流入，产⽣生了了向外的压⼒力力;
• cells swell swell and may eventually burst.
细胞膨胀，最终可能会破裂 7
http://droualb.faculty.mjc.edu/Course%20Materials/Physiology%20101/Chapter%20Notes/figure_04_17b_labeled.jpg
Movement of Fluid (Water and Electrolytes) Between Compartments
8
https://nursekey.com/wp-content/uploads/2016/11/F000035f03-02-9781437717075.jpg
Fluid Distribution
液體分佈
• At the arterial end of a capillary, hydrostatic

pressure is higher than osmotic pressure 
Filtration occurs 在⽑毛细⾎血管的动脉端，静⽔水压⼒力力⾼高
于渗透压——发⽣生过滤
• At the venous end of a capillary, osmotic
pressure is higher than hydrostatic pressure 
Absorption occurs
在⽑毛细⾎血管的静脉端，渗透压⾼高于静⽔水压⼒力力——发⽣生吸收
Fluid that cannot be absorbed (about 1.5mL/min)

at the venous end of a capillary is picked up by the
lymphatic system and then returns to the venous
circulation
⽑毛细⾎血管静脉端不能吸收的液体(约1.5mL/
min)被淋淋巴系统吸收，然后返回静脉循环
http://faculty.uca.edu/johnc/CapillaryExchange.gif
9
http://www.mayomedicallaboratories.com/images/articles/communique/2013/03-bodyfluid-testing/fluidexchng.jpg
Questions
1. Explain how a very high hydrostatic pressure in the

venous end of a capillary affects fluid shift.
2. Explain how a loss of plasma protein affects fluid

shift at the capillaries.
3. Explain how a high concentration of Na+ in the

interstitial fluid affects intracellular fluid levels.
10
Part 2 Fluid Excess
“EDEMA”
11
http://www.rayur.com/wp-content/uploads/2012/07/Congestive-heart-failure-indicating-signs-and-symptoms.jpeg
Fluid Excess: Edema
液体过剩:⽔水肿
Fluid excess occurs in the extracellular

compartment 液体过剩发⽣生在细胞外腔室
Edema refers to an excessive amount of fluid in
the interstitial compartment ⽔水肿是指间质腔内液体过多
• accumulation of tissue fluid 组织液的积累
• the osmolarity in plasma and tissue fluid affects
fluid shifts between compartments, including
the cells ⾎血浆和组织液中的渗透压影响隔间
之间的液体流动，包括细胞
• swelling or enlargement of tissue/organ 组织或器官的肿胀或增⼤大
• fluid accumulates in the tissue which becomes
soft and swollen 液体积聚在组织中，使组织变得柔软和肿胀
– can be Localized or generalized throughout
the body 可以局部化或全⾝身泛化
– severe in the lower limbs due to gravity
严重的下肢由于重⼒力力
12
http://punjabijanta.com/profile/KUDRAT%20GREWAL/?area=showThankYouPosts;start=200
⽔水肿的原因
Causes (Etiology) of Edema

⽑毛细静⽔水压⼒力力增⼤大
1. Increased capillary hydrostatic pressure 相当于⾼高⾎血压(⾼高⾎血压)
– equivalent to higher blood pressure (hypertension)
⾎血液在动脉和⽑毛
– Blood is “backing up” in the arteries and capillaries 细⾎血管中“回流”
– Filtration > Absorption in capillary beds在⽑毛细管床中过滤>吸收
– Fluid is forced out in the capillaries
液体在⽑毛细⾎血管中被挤出
Specific cases:
• Increased blood volume (hypervolemia) ⾎血容量量增加(⾼高⾎血容量量)
– Kidney failure (i.e. ischemia of kidneys) 肾功能衰竭(即肾脏缺⾎血)
– Frequently excessive Na+ levels in the extracellular fluid 细胞外液中钠离⼦子⽔水平过⾼高
– Administration of excessive fluid 给予过量量液体
• Pregnancy: the enlarged uterus compressing the venous
system 妊娠:⼦子宫扩⼤大压迫静脉系统
• Congestive heart failure: blood cannot return easily through
the veins to the heart 充⾎血性⼼心⼒力力衰竭:⾎血液不能轻
易易通过静脉回流到⼼心脏
– Raising the hydrostatic pressure in the legs and
abdominal organs
提⾼高腿部和腹部器官的静⽔水压⼒力力
@self & Associate, INC., 2005 13

http://vet.uga.edu/ivcvm/courses/VPAT5200/01_circulation/edema/edema06.html
个案研究:肺⽔水肿
Case Study: Pulmonary Edema

低PO2在⾼高空⼤大⽓气中,沿着⽀支⽓气管和细⽀支⽓气管的化学感受
器个⼈人发起⼀一个反射导致⼩小动脉的收缩在肺循环⾎血流量量
(⼀一种机制来限制在贫穷通⻛风地区),- - - - - -导致肺动脉⾼高
压肺循环的“⾼高⾎血压”。液体从⽑毛细⾎血管漏到肺泡。
Low PO2 in the atmosphere in high altitude,
the chemoreceptors along the bronchi and
bronchioles in an individual initiate a reflex leading
to arteriolar constriction in the pulmonary
circulation (a mechanism to limit blood flow in
poor ventilated region),
 Leads to pulmonary hypertension
“high blood pressure in the pulmonary circulation”
Fluid leaks from the capillaries to the alveoli.
http://advancingthescience.mayo.edu/high-altitude-pulmonary-edema/
14
http://www.beltina.org/health-dictionary/pulmonary-edema-symptoms-treatment-causes.html
Case Study: Pulmonary Edema
Pulmonary edema may also occur in

patients with the left-sided heart failure
• Left-sided heart failure is related to
pulmonary congestion
• Blood then builds up in the pulmonary
circulation
• This raises the hydrostatic pressure
there and leads to pulmonary
肺⽔水肿也可能发⽣生在左⼼心衰竭患者
•左侧⼼心衰与肺充⾎血有关
hypertension and edema
edema
•⾎血液在肺循环中积聚
这会提⾼高那⾥里里的静⽔水压⼒力力，导致肺⽔水肿
http://www.madaanhospitals.com/10a808dc0.jpg
http://static.wixstatic.com/media/e71a85_85f44ab6c4b046cf80541c251d9c9175.jpg 15
Causes (Etiology) of Edema
蛋⽩白质营养不良
2. Protein malnutrition
枯竭的胶体
• Insufficient amount of plasma proteins (i.e.
albumin) ⾎血浆蛋⽩白(即⽩白蛋⽩白)不⾜足
• ↓ plasma osmotic pressure↓等离⼦子体渗透压
• Absorption << filtration in capillary beds 吸收<<⽑毛细
管床过滤
• less fluid returns to the venous end of the
capillary
回流到⽑毛细⾎血管静脉端的液体减少
渗透压⼒力力不⾜足导致液体吸收
Kwashiorkor is a disease in poor countries due to

little protein in diet
夸希奥科病是贫穷国家的⼀一种疾病，主要是由于饮食中缺乏蛋⽩白质
Kwashiorkor
http://www.familiesforsurvival.org/wp/wp-content/uploads/2011/11/malnutrition3.jpg 16
http://www.nettesaglik.com/wp-content/uploads/2014/04/marasmus.jpg
http://vet.uga.edu/ivcvm/courses/VPAT5200/01_circulation/edema/edema07.html
⽔水肿:⾎血浆蛋⽩白缺乏
Edema: Plasma Protein Deficiency

其他导致⾎血浆蛋⽩白缺乏的情况: 肝脏疾病:肝脏不能产⽣生
Other conditions that lead to plasma protein deficiency: ⾜足够数量量的⾎血浆蛋⽩白
• Liver disease: the liver cannot produce sufficient amount of plasma proteins
• Kidney disease: Protein is lost in the urine through the kidney
肾脏疾病:蛋⽩白质通过肾脏在尿尿液中流失
• Protein is lost in burn patients
• Subsequent inflammation and loss of the skin barrier allow protein to easily leak out
of the body
17
https://thecanyonmalibu.com/wp-content/uploads/liver.jpg
https://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/visual_guide_to_liver_problems_slideshow/493ss_thinkstock_rf_jaundice_eye.jpg
Causes of Edema
淋淋巴管阻塞
3. Obstructed lymphatic vessels

• Due to inflection or tumor 由于弯曲或肿瘤
• Tissue fluid cannot return to the
bloodstream via the lymphatic system
组织液不能通过淋淋巴系统返回⾎血流
• Localized edema
局部⽔水肿
http://meded.ucsd.edu/clinicalmed/extremities.htm 18
http://www.studyblue.com/notes/note/n/ch-23-lymphatic-system/deck/4504535
Causes of Edema
炎症反应:增加⽑毛细⾎血管通透性
4. Inflammatory response: increases capillary
permeability
• Caused by histamine and other chemical
mediators released from cells flowing
tissue injury (inflammation) 由组胺等化学介质从细胞流动
中释放引起的组织损伤(炎症)
• More fluid moves to the interstitial space
更更多的液体向间隙移动
• Localized edema
局部⽔水肿
http://3.bp.blogspot.com/_EUrRZc4XR6Y/TAphcEKy81I/AAAAAAAAAPA/DtR4ft1bUU8/s1600/Picture1.jpg
19
http://classes.midlandstech.edu/carterp/Courses/bio211/chap26/chap26.htm http://medical-dictionary.thefreedictionary.com/pulmonary+edema
第三部分体液不⾜足:脱⽔水
Part 3 Fluid Deficit: Dehydration D

Main Causes of Dehydration:
1. Deficiency of water intake 1. 取⽔水不⾜足
失⽔水过多
2. Excessive loss of water 出⾎血、呕吐、腹泻、⼤大汗淋淋漓
– Bleeding, vomiting, diarrhea, excessive sweating
– Diabetic ketoacidosis 糖尿尿病酮症酸中毒
• electrolytes and glucose in the urine
尿尿液中的电解质和葡萄糖
Signs of Dehydration (Laboratory values) 脱⽔水迹象(化验值) ⾎血压明显下降(低⾎血压)，脉搏迅速⽽而微弱

1. Significant drop in blood pressure (hypotension) with rapid and weak pulses
• ↓ Blood volume  ↓ venous return ↓ ventricular end-diastolic volume
• ↓ Stroke volume and cardiac output lead to hypotension ↓⾎血容量量—↓静脉回流—
↓中⻛风量量和⼼心输出量量导致低⾎血压 ↓⼼心室舒张末期容积
• Circulatory shock 循环冲击
• a serious, life-threatening hypotensive condition 严重的、危及⽣生命的低⾎血压状况
• with rapid pulses (↑heart rate ) due to the compensation taken by the
baroreceptor reflex 由于压⼒力力感受器反射的补偿，脉搏加快(↑⼼心率)
2. Increased hematocrit in blood test [↑ the volume percentage (%) of red blood cells]
3. Decreased urine output (concentrated urine) ⾎血液比容增加[↑红细胞体积百分比(%)]
排尿尿量量减少(浓缩尿尿)
20
Urine Color Chart
21
https://www.physio-pedia.com/images/thumb/2/27/Peescale.png/443px-Peescale.png
22
https://www.researchgate.net/publication/328236530/figure/fig1/AS:680892007739394@1539348713907/How-to-assess-capillary-refilling-time-at-the-triage.png
Dehydration may lead to Heat Stroke
https://swh-826d.kxcdn.com/wp-content/uploads/2011/02/how-to-treat-dehydration.jpg 23
http://www.sciencecare.com/wp-content/uploads/2015/06/Heat-Stroke.jpg
调节⽔水的摄入量量和⽔水损失
Regulation of Water Intake and Water loss
1. Hypothalamus 下丘脑
– It Initiates a feeling of thirst 它引发了了⼀一种⼝口渴的感觉
– It consists of the osmoreceptors to monitor the plasma osmolarity
它由渗透感受器组成，⽤用来监测⾎血浆的渗透压
抗利利尿尿激素(ADH)由垂体后叶释放促进肾脏对⽔水分的
2. Antidiuretic hormone (ADH) released by the posterior pituitary 再吸收。这样可以
– Promotes water reabsorption in the kidneys. This reduces fluid loss. 减少液体流失
某些化学物质可抑制ADH
– Some chemicals can inhibit ADH secretion having a diuretic effect
分泌泌，有利利尿尿作⽤用
• Example: Alcohol prevents ADH release, which causes an increase in urine
production and dehydration. 例例如:酒精会阻⽌止ADH的释放，⽽而
ADH的释放会导致尿尿量量增加和脱⽔水。
醛固酮与⼼心房利利钠肽(ANP)
3. Aldosterone and atrial natriuretic peptide (ANP)
– Blood pressure dependent ⾎血压依赖型
– Regulate water and Na+ reabsorption in the kidneys
调节肾脏对⽔水和钠离⼦子的再吸收
4. Baroreceptors in the carotid sinus and aortic arch 颈动脉窦和主动脉⼸弓的压⼒力力感受器

– Blood pressure dependent ⾎血压依赖型
– Detect pressure changes and stimulate the sympathetic nervous system to return
the blood pressure and blood volume to normal 24
检测⾎血压变化，刺刺激交感神经系统，使⾎血压和⾎血容量量恢复正常
⽔水分過多：低钠⾎血症
低钠⾎血症指的是细胞
Part 4: Over-hydration: Hyponatremia 外腔室渗透压降低，
可能导致液体流入细
摄入过多的⽔水会导致低钠⾎血症(⾎血浆中钠的缺乏) 胞，导致低⾎血容量量
Excessive water intake leads to hyponatremia (deficiency of sodium in the plasma)
• Hyponatremia indicates a decreased osmotic pressure in the extracellular
compartment may cause a fluid shift into cells, resulting in hypovolemia
• Low sodium levels impair nerve conduction and may lead to seizures 低钠⽔水平损害神经传
• Brain cells may also swell, causing confusion and headache 导，可能导
脑细胞也可能膨胀，引起混乱和头痛致癫痫发作
癫痫是⼀一种由不可控的肌⾁肉
活动引起的暂时的、不⾃自主
的对正常的呼吸功能的⼲干扰
Videos:
http://epilepsyontario.org/research-and-resources/seizure-videos/
25
http://healthbox201.com/wp-content/uploads/2017/12/SeizuresInDogs_2.jpg
Over-hydration (Excess Water Ingested):
Hyponatremia
Prevent Hyponatremia:
Drink a fluid containing water, glucose,
and electrolytes. This would be better
than drinking tap water.
26
https://slideplayer.com/slide/13665865/84/images/12/Hyponatremia.jpg
END
27

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Introduction to Human Diseases: Physiology and

• Explain the significance of inflammation to the development of human

• Discuss the etiology, symptoms, and treatments of common diseases in the

• Explain the molecular and cellular mechanisms for various disease

• Discuss the pathophysiology of neonatal diseases and age-related diseases

• Describe different types of disorders in the

• Describe different types of thyroid disorders

• Most endocrine disorders belong to one

• Imbalance of the endocrine system → The concept of “yin and yang” is

• Primary: Endocrine gland functions

• Secondary: Endocrine gland is normal but

• Hypo-responsiveness: Target 去甲腎上腺素 腺苷酸环化酶

• Hypothalamus and pituitary are 合成營養激素的神

Pituitary disorder: Pituitary adenomas

• Signs and symptoms:

→ ↑ pressure in the skull, headaches,

- Tumor cells may destroy some or all pituitary

• Gigantism: Excess GH secretion before puberty

• Acromegaly: Excess GH secretion in adults (after

• Dwarfism can be treated by

Lionel Messi is a famous footballer

• Surgery (e.g. endoscopic endonasal

Pituitary disorder: Diabetes insipidus (DI)

• Signs and symptoms: Polyuria (large

• Treatment: Replacement therapy for

Pituitary disorder: Syndrome of inappropriate ADH

secretion; can be triggered by stress or

• Signs and symptoms: Hyponatremia (low

• Treatments: Diuretics (drugs which

Disorder Serum Na+ Serum Urine

circulating) and triiodothyronine

• Secretion is initiated by TRH

• Negative feedback to pituitary

• Toxic goiter is associated with an autoimmue

• Treatments: Radioactive iodine, surgical removal of

• Examination of T3 and T4 levels

• Testing of serum TSH levels

• Uptake of radioactive iodine

• CT scans for presence of tumor

• Acromegaly can lead to uncontrolled growth in patients. Watch the following

• Describe the causes, symptoms and treatment

• Understand the pathophysiology of various adrenal

• Parathyroid glands are 4 round

• Major function is to secrete

• PTH and calcitonin represent two

• PTH is secreted from parathyroid

2. ↑ Ca2+ reabsorption in kidneys

3. Stimulating kidneys to synthesize

• PTH and calcitonin are antagonistic (opposing) hormones

Why maintenance of blood Ca2+ is important?

Ca2+ ions are required for:

• Bone and teeth formation

• Neurotransmitter release from neurons

• Muscle contraction and normal heart

• Signal transduction (as second

• Hypoparathyroidism (lack of PTH) may be due to:

• Signs and symptoms: Low serum calcium levels

• Cause: Hyperparathyroidism is due to

• The cause can be primary or secondary:

• Cause: Adenoma (benign tumor), hyperplasia, or

• Signs and symptoms:

• Treatment options will depend on

• Adrenal cortex: Endocrine cells 肾上腺⽪皮质:内分泌泌细胞

• Hypo-responsiveness: Target 去甲腎上腺素腺苷酸环化酶