Ateneo - UPO

The course covers the pathophysiological basis of the main syndromes and clinical conditions of Internal Medicine, with the aim of guiding students from the understanding of altered biological mechanisms to the recognition of clinical manifestations and the interpretation of major laboratory and instrumental findings.Particular attention is devoted to cardiovascular pathophysiology, including heart failure, shock, arterial hypertension, venous and arterial thrombosis, and pulmonary embolism. The course also addresses the pathophysiological mechanisms of respiratory failure, gas exchange, oxygen transport, acid-base disorders, and arterial blood gas interpretation.The course further includes elements of the pathophysiology of electrolyte disorders, diabetes mellitus, and basic electrocardiographic interpretation, integrating physiological knowledge with clinical reasoning and applied examples.

Teaching materials provided by the lecturer during the course, including slides, slide notes, possible clinical cases, and supplementary resources, constitute the primary reference for examination preparation.Recommended textbook:Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine. 8th ed. McGraw Hill; 2018.Texts for optional consultation and personal further study:Rugarli C. Medicina Interna Sistematica. 8th ed. Edra; 2021.Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, et al. Harrison's Principles of Internal Medicine. 22nd ed. McGraw Hill; 2025.Students are not expected to study the listed textbooks in their entirety. The recommended and reference texts are intended as supporting resources to consolidate or expand, where desired, the chapters relevant to the topics covered during the course.

The course aims to provide students with the conceptual tools required to understand the main pathophysiological mechanisms underlying diseases and syndromes of relevance to Internal Medicine.The central objective is to support the transition from knowledge of normal physiology to the understanding of its alterations, guiding students in linking biological and functional damage to the development of signs, symptoms, changes in vital parameters, laboratory abnormalities, and instrumental findings.The course also aims to develop a rational approach to clinical reasoning, based on the interpretation of disease mechanisms rather than on the mere descriptive memorization of diseases. Particular attention is devoted to the integration of physiology, pathophysiology, and clinical medicine, with examples related to major cardiovascular, respiratory, metabolic, thromboembolic, and electrolyte disorders.By the end of the course, students are expected to have acquired an integrated view of pathological processes, enabling them to critically interpret complex clinical presentations and to approach subsequent clinical courses within the Degree Program in Medicine and Surgery with greater awareness

Successful participation in the course requires basic knowledge of human anatomy, physiology, biochemistry, and biomedical physics, acquired during previous courses within the Degree Program.Students are also expected to have a general understanding of the organization and function of the major organs and systems, particularly the cardiovascular, respiratory, renal, and endocrine-metabolic systems, in order to understand the pathophysiological alterations discussed during the course.

The course is mainly delivered through face-to-face lectures, supported by multimedia presentations and teaching materials made available on the DIR online platform.During lectures, theoretical topics are integrated with clinical examples, guided discussion of pathophysiological conditions, and interpretation of clinical, laboratory, and instrumental parameters of common medical relevance.Ongoing formative assessment is encouraged through questions addressed to students during lectures, aimed at stimulating active participation, pathophysiological reasoning, and the ability to link disease mechanisms to clinical manifestations.

Class attendance is regulated according to the Degree Program requirements.Teaching materials made available on the DIR online platform constitute an integral part of the learning process and should be used together with class attendance and individual study.Any organizational communications, updates to teaching materials, or information concerning the course will be provided during lectures and/or through the DIR online platform.

Assessment is carried out through a written multiple-choice examination covering the topics of the integrated course in Pathophysiology and Medical Semiology.Unless otherwise specified by the organization of the integrated course, the examination includes 30 questions on Medical Pathophysiology and 60 questions on Medical Semiology. Each question consists of four answer options, with only one correct answer.The examination is administered through the DIR online platform in sequential mode. The total duration of the examination and any specific operational instructions are communicated to students before the test.The questions are designed to assess knowledge of the main pathophysiological mechanisms covered during the course, the ability to interpret alterations from normal physiology, and the capacity to link clinical, laboratory, and instrumental findings to the underlying pathological processes.

The course addresses the pathophysiological basis of the main syndromes of relevance to Internal Medicine, with particular attention to the link between altered physiological mechanisms, development of signs and symptoms, interpretation of clinical data, and diagnostic reasoning.The course initially reviews selected principles of cardiovascular physiology that are essential for understanding cardiac function and systemic perfusion, including preload, afterload, contractility, stroke volume, ejection fraction, cardiac output, the Frank-Starling mechanism, Laplace’s law, and the ventricular pressure-volume loop. On this basis, the pathophysiology of heart failure is discussed, distinguishing heart failure with reduced ejection fraction and heart failure with preserved ejection fraction, with reference to mechanisms of myocardial injury, ventricular remodeling, neurohormonal activation, pulmonary congestion, and reduced exercise tolerance.A major part of the course is devoted to shock, understood as a condition of tissue hypoperfusion and an inadequate relationship between oxygen delivery and oxygen consumption. Definition, classification, and pathophysiological mechanisms of hypovolemic, cardiogenic, obstructive, and distributive shock are discussed. Particular attention is paid to the meaning of mean arterial pressure, pulse pressure, cardiac output, systemic vascular resistance, central venous pressure, and pulmonary capillary wedge pressure. The role of the microcirculation, endothelium, anaerobic metabolism, lactate, and multiorgan dysfunction is also addressed.The course includes respiratory pathophysiology and arterial blood gas interpretation. The principles of gas exchange, alveolar ventilation, alveolar-capillary diffusion, ventilation/perfusion matching, shunt, and the alveolar-arterial oxygen gradient are reviewed. The main mechanisms of hypoxemia, oxygen and carbon dioxide transport, arterial oxygen content, oxygen delivery, and the relationship between hypoxemia, tissue hypoxia, and respiratory failure are discussed. The pathophysiological basis of acid-base disorders is also addressed, with particular reference to respiratory acidosis and alkalosis, metabolic acidosis, anion gap, metabolic alkalosis, and respiratory and renal compensatory mechanisms.The course covers the pathophysiology of essential and secondary arterial hypertension, correct blood pressure measurement, the pathophysiological meaning of systolic, diastolic, and pulse pressure, arterial stiffness, and the main target-organ complications of chronic hypertension.The course also examines the pathophysiology of venous and arterial thrombosis. Topics include Virchow’s triad, major thrombotic risk factors, inherited and acquired hypercoagulability, endothelial injury, venous stasis, differences between arterial and venous thrombosis, deep vein thrombosis, and pulmonary embolism. The pathophysiological mechanisms of atherosclerosis, atherosclerotic plaque formation and progression, plaque vulnerability, and acute arterial thrombosis are also reviewed.Finally, the course presents elements of the pathophysiology of electrolyte disorders, with particular attention to hyponatremia, hypernatremia, hypokalemia, and hyperkalemia, as well as general principles of the pathophysiology of diabetes mellitus, including beta-cell dysfunction, insulin resistance, glucotoxicity, lipotoxicity, and the main differences between type 1 and type 2 diabetes mellitus. The course also includes a basic methodological approach to electrocardiogram interpretation, aimed at recognizing the main abnormalities of pathophysiological relevance.Topics are developed by integrating physiological background, explanation of pathophysiological mechanisms, clinical examples, interpretation of laboratory and instrumental data, and in-class formative questions, in order to promote pathophysiological reasoning and the ability to link disease mechanisms to clinical manifestations.

By the end of the course, students will be able to:understand the main pathophysiological mechanisms underlying the syndromes and clinical conditions covered during the course;recognize the main alterations from normal physiology involving the cardiovascular, respiratory, renal, endocrine-metabolic, and hemostatic-coagulation systems;link pathophysiological alterations to the development of signs, symptoms, changes in vital parameters, laboratory abnormalities, and instrumental findings;interpret selected basic clinical and instrumental data using a pathophysiological approach, with particular reference to blood pressure, hemodynamic parameters, arterial blood gas analysis, acid-base balance, electrolyte disorders, and basic electrocardiographic findings;distinguish the main pathophysiological mechanisms involved in heart failure, shock, respiratory failure, arterial hypertension, thrombosis, pulmonary embolism, electrolyte disorders, and diabetes mellitus;apply pathophysiological knowledge to clinical reasoning by formulating interpretative hypotheses consistent with the available data;use appropriate medical terminology to describe the main pathophysiological processes and their clinical manifestations;integrate the acquired knowledge with subsequent clinical courses within the Degree Program in Medicine and Surgery.