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General teaching about disease
Classroom Etiquette:

   Turn off iPads and cell phones !
   No tobacco use of any kind
    Be considerate of others:
     Take out what you bring in.
       Talk to me, NOT your neighbor!
       Remember for personal hygiene - cleanliness above all!
         Do not ask for release of classes, you are able
    go to the dean’s office and student’s clinic!
   NO:
       Be Late (in case You are late - look above ↑ )
       Plagiarism
       Cheating
       Allowing others to copy from you
   Penalties can be severe !!!
   REWORKS – every Monday at 4 p.m. (till last student)
Terminology
   Pathology – focus on physical changes in diseased
    organs and tissues
   Pathophysiology – abnormal functioning of
    diseased organs and how it applies to medical
    treatment and patient care
Pathological physiology is the science, which studies the
  general law fullness of disease genesis, development and
  the end.
This is the science about the vital activity of sick organism.
Pathological physiology is the study of the most common
  options of the disease genesis and development, while
  clinical sciences study specific items of disease prevention,
  diagnostics and treatment.

Pathological physiology, as a science, solves the following
  problems:
 illness essence establishment;
 disease causes and it’s beginning conditions study;
 illness development, display, course and the convalescence
  mechanisms separate explanation;
 diseases prevention and cure general principles
  determination.
The pathological physiology is related to the other
sciences. The following connections are:
a) to the sciences, which study illness causing environmental factors
    (physics, chemistry, biology, microbiology, the social sciences), they
    are necessary for etiology studying;
b) to the sciences, which study the organism properties and its vital
    functions (cytology, embryology, histology, the normal physiology,
    biochemistry, immunology, genetics), they create a base for
    pathogenesis study;
c) to general theoretic sciences, which study an the disease (pathological
    anatomy, pharmacology), in common with pathological physiology
    create a total picture of the illness;
d) to the clinical sciences, helping to
   determine the basic etiological and
   pathogenic principles of disease
   prevent, diagnostics and cure.
The clinic arises the problems and
gives the necessary material for their
solvation to pathophysiologists.
The connect between the pathophysiology
                  and other disciplines
Methods of
     Pathophysiolog y
1. Clinical
2. Epidemiological
3. Anatomic
4. Experimental
 The peculiarity of pathophysiological
  experiment is the reproducing of the
  experimental disease models upon
  laboratory animals with the purpose to
  establish the mechanisms of their genesis,
  development and in human organism.
•   The experimental disease model is the artificial reproducing of disease up
    the laboratory animals, which has the same lines of the proper human
    disease.
•   Though an experiment up animals does not give us the full picture of the
    proper human disease, it enables to observe and to study the disease
    course the beginning to its completion, that is impossible in clinics. During
    the experiment one can control the environmental conditions, which
    influence upon the illness course and have the objective material for the
    scientific theories construction.
•   The experiment can be divided into the acute and the chronic one.
•   The acute experiment is based on the surgical intervention in animal
    organism. It examines the acute disorders in organism (shock, collapse,
    sharp breathing insufficiency, blood circulation insufficiency, etc).
•   The chronic experiment is a protracted one, shows the illness
    development dynamics. It is used for chronic diseases modeling (diabetes,
    atherosclerosis, arterial hypertension, ulcerous disease etc).
 Pathological physiology consists of such parts:
► the general pathology and
► the pathophysiology of the organs and systems.
 The general pathology unites such parts:
► nosology,
► pathogenic environmental factors action,
► inner factors role in pathology, 
► typical pathological processes,
► the typical metabolic disturbances.
 The pathophysiology of organs and systems
  studies the general development of pathological
  processes in separate functional systems; the most
  widespread nosological forms are etiology and
  pathogenesis .
The general nosology
     includes such notions:
health
disease
pathological process
pathological state
pathological reactions
Nosology
►   Nosology (fr. Gk nosos, disease + logos, science) is a general
    science of diseases including the basic concepts and categories of
    pathology, classification and nomenclature of diseases, social aspects
    of pathology.
►   Nosology deals with many problems: building basic scientific terms,
    used in medicine: Health and Disease, pathological processes,
    conditions, pathological reactions, stages of a disease, its
    complications, and other terms which are of medical importance.
►   Development of nomenclature of diseases and their conditions.
►   Building a classification of diseases.
►   Laying the foundations for the general study of diseases.
►   Developing a theoretical conception of medicine.
►   Basic concepts of nosology:
►   Health, disease, normal, pathological reaction, pathological process
    and pathological conditions.
TERMINOLOGY
• Etiology (fr. Gk aetia, reason + logos, science) is the science of
  causes and conditions of disease occurrence. Etiology studies
  general properties of pathogenic factors, basic categories of
  pathogenic factors, significance of conditions in occurrence of
  diseases, principles of etiotropic prophylaxis and etiotropic
  therapy.
• Pathogenesis (fr. Gk pathos, disease + genesis, origin) is the
  science of mechanisms of development, course and outcome of
  diseases. The science of pathogenesis includes: mechanisms of
  stability of organism to the action of pathogenic factors, general
  mechanisms of development of diseases, mechanisms of
  recovery, mechanisms of dying, principles of pathogenetic
  prophylaxis and pathogenetic therapy.
• Biological modeling is an artificial reproduction of disease
  processes in a living organism (in a cell, organ, entire organism).
TERMINOLOGY
•   A pathological reaction (fr. Gk pathos, affliction, disease; Lat. re- -
    against, actio - action) is an organism response to extraordinary irritant,
    which is sometimes a symptom of disease.
•   A pathological process is a complex of pathological and protective-
    adaptative reactions as a response to a damaging effect of a
    pathological factor.
•   A typical pathological process is a pathological process developing in
    accordance with the same rules, irrespective of reasons and localization.
•   A pathological function (fr. Gk pathos, affliction, disease; Lat. functio,
    activity) is a disorder of function of a cell, tissue, organ, system of organs
    and vital activity of organism).
•   A pathological reflex (fr. Gk pathos, affliction, disease; Lat. reflexus,
    reflected) is a disorder of functional activity of organs, tissues or
    systems, occurred with participation of CNS in response to pathogenic
    irritation of receptors and manifested as pathological reactions of
    organism.
•   A pathological condition (status pathological) is a stable abnormality of
    organism functions, a sluggish pathological process or the consequence
    of an earlier suffered pathological process.
Health is the condition of complete
physical, psychic and social well-
doing, but not only diseases or the
physical defects absence (WHCO –
World Health Care Organization).
 In doctor’s practical activity determination is used,
 according to which health is the condition of a norm. There
 is a question: what is the norm?
 There are two approaches to this notion determination: the
 statistic and the general physiologic one.
 According to the first one, the norm is the condition, which
 is the most frequently observed among people.
  According to the second one, the norm is the biological
 optimum of the organism functioning and development.
 The second determination reflects the scientific approach
 to the notion which is “a norm”. However this approach
 remains still unrealized because of our knowledge and
 possibilities limitation.
Disease – loss of
homeostasis, or when physical
or mental capacities cannot be
fully utilized (interuption,
cessation or disorder in the
function of an organ or
system).

   The disease is disturbance of human
    organism vital activity under the influence of
    extraordinary factors of external or inner
    environment which is characterized by
    lowering of capacity for work and adaptation
    with simultaneous mobilization of protective
    forces.
• Stages of a Disease.
1. The latent period or incubation period of an infectious disease.
    The incubation period of a disease lasts from some hours to
    some days or years. The patient must be isolated or
    hospitalized.
2. Prodromal period of a disease. The patient develops
    generalized clinical symptoms of a disease (complaints of a
    headache, slight malaise, chills, rheumatic pains in his joints as
    well as muscular pains). The doctor can make a preliminary
    diagnosis in this period of disease development.
3. Dromal period of a disease. It is marked by all clinical
    characteristics of a disease. In the dromal period the patient
    develops all specific clinical symptoms. The doctor has to make
    the final, basic diagnosis in this period of disease
    development.
4. Outcome of a disease will be favorable or unfavorable.
     – recovery - complete or incomplete
     – recurrence
     – chronic disease –remission and exacerbation
•   Terminal state
•   preagonal state
•   agonal state
•   clinical death
•   biological death.
   The diseases endings are following: convalescence ( complete
    and incomplete), recurrence, into chronic form transition, the death.
   The convalescence is the process, which conduces to the
    violations liquidation, caused by an disease, and normal relations with
    the environment  restoration, for human beings – foremost the ability
    to work restoration. The full convalescence is the state when all the
    disease signs disappear and organism restores its adaptation
    possibilities completely. When the convalescence is incomplete the
    disease consequences are expressed. They remain for a long time or
    forever. The convalescence is provided by the urgent (emergency)
    and lasting protectively-compensational reactions of the organism.
   The remission is the temporal state improvement of the human
    being, which is displayed by the disease progressing slowing down or
    cessation, the partial reverse development or the disappearance of
    the pathological process clinical signs.
   The recurrence is the new disease display after its seeming or
    incomplete cessation.
   The complication is secondary as for reference to the disease
    pathological process.
   The transition in the chronic form signifies that disease courses
    slowly with the protracted remission periods (months and even
    years). So, many diseases acquire chronic nature in old age (chronic
    pneumonia, chronic colitis).
The terminal states are the boundary ones between life
and death. This is also the dying, which include a few stages:
     pre-agony, agony, clinical death, biological death.
►   The preagony is characterized by the diverse duration (during hours, days) of
    deep violations of the vitally important organism functions. The dyspnea, the
    decreasing of the arterial pressure, the darkening down of the consciousness,
    which are observed in this period. Gradually the pre-agony gets across in the
    agony.
►   The agony is characterized by the gradual turning down of all organism
    functions. The agony lasts 2-4 minutes, sometimes more.
►   The clinical death is such condition when all of the visible sparks of life have
    already disappeared (the breathing and the heart work are ceased, however the
    metabolism still continues). The life can be restored on this stage.
►   The biological death is characterized by the irreversible changes in the
    organism.
►   The reanimation of the organism includes number of measures which are
    directed foremost to blood circulation and breathing renewal: heart massage, 
    artificial lungs ventilation, heart defibrillation. The indirect heart massage is
    widely used for the renewal of blood circulation, it can be used at once after the
    clinical death setting in any conditions and even not by specialist. The artificial
    ventilation of the lungs also must be started as soon as possible. The heart
    fibrillation is observed in the terminal period ordinary. In such cases the electric
    defibrillation is used. A single digit to 6000 V removes the fibrillation and
    promotes the renewal of the blood circulation.
Cause of a Disease
•   One of the most important and difficult
    questions is the problem of establishing the
    cause of a disease. The tactics of the
    physician and the success of treatment of
    various diseases depend on the correct
    solution of this problem. Pavlov believed
    that a problem of etiology is the least
    investigated problem of medicine. In the
    course of development of natural history the
    theory of etiology of diseases has been
    changing. Each etiological theory was
    influenced by the dominant ideas of the
    time it was formed at. The old theory could
    not account for new facts. There were two
    ways of doing research: either to deny the
    facts or to change theories interpreting
    them.
•   The ancient medicine gave rise to the idea
    of a causative agent as a major etiological
    factor. XVII –XVIII centuries witnessed the
    development of a new doctrine known as
    mechanical determinism.
Theories
•The mechanical determinism of XVII-XVIII
centuries was of great significance for the
development of the theory of pathology. Within a
framework of mechanical determinism some basic
methods of establishing causal connection (method
of isolation, method of similarity, method of
differences, method of attendant changes, method    Louis Paster
of remainder) were elaborated. These methods are
still of great importance nowadays.
• The important stage in the development of this scientific
  trend was elaboration of the theory of mechanical
  monocausalism.
• The origin of this theory was prompted by discoveries of
  infectious pathology. Within a short period of time the
  causative agents of most widespread infectious diseases
  were discovered which was inspired by Paster’s idea that
  diseases may be caused by infectious agents. Many
  scientists overestimated the importance of microbes in the
  development of diseases.
Theories
•   Monocausalism was most fully reflected in the conception of Genle -
    Kock:
•   A certain microbe causes a certain disease, it can be found neither in
    healthy people nor in people suffering from other diseases.
•   A microbe can be isolated in a pure culture.
•   Pure microbial culture will cause the disease whose causative agent it is
    supposed to be in experiment.
•   This conception was of great importance as it channeled the research into
    discovering numerous microbes.
•   However, there was some clinical evidence which contradicted this
    conception. Firstly, the study of severe epidemics revealed that not all
    people get infected and develop a disease. Nor all of those infected die.
    Secondly, there was experimental evidence that a hen which is not subject
    to anthrax in ordinary conditions dies if its legs are kept in cold water for a
    while. Thirdly, milkmaids that had had cowpox did not catch smallpox
    during epidemics.
•   Finally, in 1884 Lefler discovered the fact of carriage of bacilli. He found
    virulent streptococci and pneumococci on the mucous membranes of the
    pharynx and on the tonsils of healthy people.
Theories
Later a new theory of conditionalism gained popularity.
The founder of that theory was Ferworn. He formulated
five principles of this conception.


1. The first of them is as follows. There are no isolated and absolute
   things. All processes or states are conditioned by other processes or
   states.
2. There are no processes or states which are determined by a single
   factor. All processes or states are conditioned by a large number of
   factors (doctrine of multiple conditions).
3. Every process or state is unequivocally determined by the sum of their
   conditions
4. Every process or state is identical to the sum of their conditions.
5. All conditions of any process or state are equally significant.
• Conditionalism is a subjective idealism theory. Microbes alone can not
   account for the origin of infectious processes. But we should not
   underestimate the role of microbes in this process.
Theories
• Another step in the development of the doctrine of
  etiology is constitutionalism. The founders of this
  theory believed that diseases may be caused by a
  constitution type. These types are as follows: normal,
  asthenic or hyperstenic constitution. Each type of
  constitution has its own peculiarities. People of asthenic
  constitution are subject to stomach ulcer and
  tuberculosis. People of hyperstenic constitution are likely
  to suffer from myocardial infarction or bronchial cancer.
  This theory is based on the theses of formal genetics
  and on genotype invariability. However, a genotype can
  change under the influence of many exogenous and
  endogenous factors. Therefore, this theory can not be
  considered true.
Theories
The next theory was elaborated by Zigmund Freud.
This author distinguished three main systems in the
psychic (mental) structure of a person: the conscious,
the subconscious and the unconscious. The latter is the
home for sexual instincts.
 • The conscious constantly suppresses these instincts. Freud believed that a
    daughter’s love for her father, a son’s love for his mother are manifestations of
    sexual instincts. Human consciousness constantly suppresses these sexual
    instincts. But having a high power charge they tend to struggle their way to
    consciousness. This results in the development of numerous diseases such as
    schizoprenia, epilepsy, neurosis, etc.
 • Zigmund Freud's conception had a great effect on the western medical science.
    It also gave rise to a new branch of medicine, i.e. psychosomatic medicine. The
    supporters of this branch of medical science suppose that diseases may be
    caused by psychological conflicts in childhood. Different pathological processes
    are conditioned by different stages of children’s development when disorders
    occur.
 • Under 6 months of age an infant seeks for his mother’s love and has a food
    instinct. Disorders at this age lead to bronchial asthma or ulcer. Under 3 years of
    age a child has an inclination for analysis. They often break their toys and other
    things. If parents forbid to do this a child gets aggressive and spasms of the
    muscular system occur. From 3 to 6 years a child develops a sense of self and
    sexual feelings. Disturbances at that age will result in hysteria and in various
    sexual disorders.
•   Thus, we have outlined the main theories of etiology in medicine. Nowadays
    etiology is a theory of causes and conditions of a disease development.
•   A cause determines specificity and quality of the bodily reaction to a
    pathological process. A cause also determines connections and regularities
    of the processes. For example, tuberculosis is caused by Micobacterium
    tuberculosisIt is responsible for specific and morphological changes typical
    of it.
•   The following these underlie the modern idea of causality:
•   All natural phenomena have their own cause, there are no causeless
    phenomena.
•   The cause is material, it is independent of our existence.
•   The cause interacts with the organism. Changing the body, the cause
    changes itself.
•   The cause gives a new quality to a process. It is the cause that makes a
    pathological process special and unique.
•   Classification of causes:
•   Exogenous: physical, chemical, biological, psychic/mental and social.
•   Endogenous.
•   Conditions.
•   Psychic/mental conditions in childhood.
•   Urbanisation.
•   Industrialisation.
•   War.
•   Unemployment.
The diseases classifications are
    based on the following criterias:
•   1. The etiological classification is founded on the cause community for
    the diseases group. For example, there are the infectious and uninfectious
    diseases. According to the same principle one can group the diseases
    caused by an intoxication (food, professional), genes violations and
    chromosomal mutations (hereditary diseases) etc.
•   2. The topography-anatomic classification is based on the organ
    principle: the cardiovasculars diseases, diseases kidneys, diseases of
    nervous system etc. It is comfortable for practice. Besides, it corresponds to
    the modern specialization of the medical help. It combines with the
    classification of the functional systems: blood system, digestive system,
    musculosceletal apparatus diseases etc.
•   3. The age and sex disease classification. There are the children’s
    diseases, the senile age diseases. The female genitals diseases are studied
    by the gynecology.
•   4. The ecological diseases classification proceeds from the human
    dwelling conditions: the air temperature, the atmospheric pressure, the sun
    illumination.
•   5. The classification according to the pathogens commonness: allergic
    and inflammatory diseases, neoplasms, shock, hypoxia.
The general etiology
• The etiology is the learning of  disease
  beginning causes and conditions. The notions
  of causality and determinism are base of
  etiology.
• A causality reflects an objectively existent
  phenomenas connection, when one
  phenomenon (cause) inevitably causes
  beginning of the other phenomenon (result)
  by the definite conditions. Any disease just
  like a phenomenon has its own cause. The
  beginning and the development of the disease
  are not by chance but subordinated to the
  definite lawfullness.
Classification of etiological factors
   They are exogenous (external) and endogenous (internal).
       The exogenous factors:
   a) physical – mechanical influence, radiation, high and low
    temperature, electric current, overloading, zero-gravity      and
    others
   b) chemical – the inorganic and organic compound;          c) biological
    – viruses, rickettsias, bacterias, Protozoas, helmints, Arthropodes
   d) psychic – a word
   e) social – society development level, traditions and others
     The endogenous factors:
   heredity
   constitution
   age
   sex
   organism reactivity
Categories of etiology
Genetic disease– genes are responsible for a structural
or functional defect
Congenital disease– genetic information is intact, but
the intrauterine environment interferes with normal
development
Acquired disease – disease is caused by factors
encountered after birth (biological agents, physical
forces, and chemical agents)
Clinical manifestations – indications that the person is
sick
Symptoms – unobservable effects of a disease reported
by the patient
Signs – observable or measurable traits
Syndrome - a characteristic combination of signs and
symptoms associated with a particular disease.
Pathogenesis - sequence of events in the of development of a disease
Sequelae – lesions or impairments resulting from a disease
Acute conditions – rapid onset, develop quickly, usually of short
  duration
Chronic conditions – longer duration onset may be sudden or
  insidious
Distribution of lesions may be:
  Local – confined to one area of the body
  Systemic – widely distributed throughout the body
Within an organ damage can be:
  Focal if there are only one or more distinct sites of damage
  Diffuse if the damage is uniformly distributed
Diagnosis – identification of the specific disease
Therapy – the treatment of the disease to either effect a cure or
  reduce the patient’s signs and symptoms
Prognosis – prediction of a disease’s outcome
Risk Factors
The risk factors are the factors
  combinations, the presence of which in
  people population statistically increases
  morbidity by definite diseases. The
  belonging of these or those conditions to
  the risk factors is determined
  by epidemiological methods, which envelop
  the large people contingent.
So it was established, that the violation of
  blood plasma lipid composition, arterial
  hypertension, the age, belonging to male,
  obesity, hypodynamia, hereditary factors,
  stress are the atherosclerosis risk factors.
Adaptation and compensation
   The base of adaptation and compensation are the
    same mechanisms which are named protective
    -adaptation or protective-compensatory. The distinction
    between these notions: is adaptation develops in
    augmentation of the action intensity of usual factors
    environmental. The damage hasn’t happed yet, and the
    homeostasis indexes are coming to the extreme norm
    borders. The compensation develops in the action of
    the pathogenic factors when a damage takes place and
    the homeostasis indexes are beyond the extreme
    borders norms.
Adaptation and compensation in disease
    development
    1. The stage of immediate adaptation and compensation. The
     mobilization of existing mechanisms and reserves begins and as a
     result of loading on functioning system unit increases, its
     hyperfunction develops. On this stage the events develop according
     to such scheme: the action of pathogenic factors → the violation of
     homeostasis → the perception of homeostasis violation → regulatory
     centers → immediate protective reactions (specific and unspecific)
     → the hyperfunction of proper structures, supporting homeostasis.
    2. The stage of the long duration adaptation and compensation. The
     augmentation of systems power, responsible for adaptation and
     compensation is its base. It is reached by the augmentation of the
     structures amount, providing a hyperfunction, so hypertrophy
     develops. The hyperfunction → violation of intracellular homeostasis
     → activation of genomes → decrease of the proteins synthesis →
     cell hypertrophy.
The general pathogenesis
•    The pathogenesis is the study about the mechanisms of the
     development, the course and the end of disease. The pathogens
     studies everything taking place after the cause action.
•    It is necessary to mention the following questions in disease pathogenesis
     consideration:
1)   the role of etiological factor in disease development;
2)   the organism reactivity significance for the disease beginning and the course;
3)   the significance of the general and local changes and their correlation;
4)   the basic link of pathogens and causally-investigation intercourses;
5)   the significance of functional and morphological changes and their correlation in
     disease;
6)   the significance of nervous system functional changes for disease development.
             There are three variants of connections between a
                          cause and a pathogens:
1) Etiological factor initiates the pathologic process and then disappears, so the
    pathogenesis develops without etiological factor (trauma, radiation).
2) The cause continues its action throughout all the period of the development of
    the disease (infectious disease), as consequence the etiological factor
    penetrates into pathogenesis, exist in it and influence it.
3) Persistence of the cause agent, which causes the disease, is delayed in
    organism (healthy bacilli-carrier).
How does pathogenesis divide?
        (four periods of pathogenesis)
• The pathogenesis is a new complicated process in the
  organism with the two quite opposite processes:
• 1) "the measure against the disease" (by I.Pavlov) — it
  means the compensatory and protective reactions
• 2) "pathologic process proper"
• So, the pathogenesis is a unity of opposites, which always
  fight (law of dialectics). The doctor must find out pathologic
  process the proper and stimulate the protection. There are
  four stages of pathogenesis:
• 1) latent period (incubation period of the infectious
  diseases); 2) prodromal one; 3) the period of expressed
  manifestations; 4) the outcome of the disease.
Local and Systemic in Pathogenesis

• The study of pathogenesis of diseases proved that hare
  are neither purely local nor purely systemic diseases.
  The effectiveness of treatment depends on the correct
  understanding of this idea.
• All diseases are local and systemic at the same time,
  which determines the development of processes. Dental
  caries can be treated using a stopper. If caries results
  from a systemic disorder of mineral and albumin
  exchange it requires a general treatment.
• The correlation between local and systemic changes
  must be timely considered.
• A local process, for example, a furuncle can develop as
  a result of the impairment of defense mechanisms of the
  organism which limits this process and makes it local.
Local and Systemic in Pathogenesis
Causally-investigation
          Relations
   The changes in organism which arise during disease development are in definite
    causally-investigation relations, it means that the same phenomenon of
    pathogens is the result of violations and cause of other. Such type of causally-
    investigation relations when the definite links  the pathogens over violation
    sequence bring to their heightening over so called “the vicious round ”. It
    supports itself the pathogens of the disease and redoubles its course. So, in
    pathogens of any shock lowering of arterial pressure has big significance that
    becomes cause of anoxaemia. The cerebral hypoxia brings to the oppression of
    vasomotor centre and greater lowering of arterial pressure (a circle locked).
   The main link of pathogens is the process which is necessary for a development
    of all the rest. The liquidation of the main link in time brings to removal of
    pathological process as a whole. The main principle of pathogenetic diseases
    cure is founded on it. So, in diabetes mellitus the insulin lack is the main link of
    pathogens. Its liquidation (the introduction of hormone) brings to disappearance
    of  other displays (hyperglycemia, glucosuria, polydipsia, ketonemia, comas).
   In  pathogens  specific and unspecific processes and mechanisms are always
    combined. The specific ones depend on the cause properties and determine the
    basic disease descriptions. A search of the specific signs lays in base of 
    diseases recognition (diagnostics).
Vicious circle
 Causes and consequences
 constantly change their
 places. The cause
 (etiological factor) causes
 the pathologic reactions
 (process) and than these
 reactions return to the first
 agent (etiological factor)
 and intensify it. So "vicious
 circle" is formed m
 pathogenesis For example,
 if arterial pressure decrease
 it causes the hypoxia and
 than vasomotor center
 depresses. It leads to the
 prolonged decrease of
 arterial pressure.
Nonspecific and Specific
Signs
 Every disease can have its signs that are typical of this
  disease only (for example, irradiation of the pain in
  angina pectoris), while other signs are typical of many
  diseases or even for all. This common nonspecific
  aspect of pathogenesis depends on the reactions of the
  organism developing in the course of evolution and is
  hereditary. There are five nonspecific reactions:
 Parabiosis. This is stable, non-spreading excitation,
  which occurs in damaged excitable tissues. It is
  important in pathogenesis of some forms of cardiac
  blocade.
 Dominant reaction. This is a condition of a stable rise of
  excitability of the group of nerve centers, which regulates
  the overall activities of the body. The dominating
  motivation gives rise to other dominants such as
  nutritional, sexual, etc.
Negative effect of changes of atmospheric pressure
   A man feels the effect of decreased atmospheric pressure during ascent on plane or in mountains, or the
    pilots flying in nonhermetically sealed cabin.
   The pathologic changes, occurring in it, are caused by two main factors:
   a) decrease of partial pressure of oxygen in inspired air;
   b) decrease of atmospheric pressure (decompression).
   The clinical signs of decompression syndrome are: pain in the ears and frontal sinuses because of expansion
    of air in these cavities, nasal bleeding, because of bursts of small vessels. Bursting of alveoli and vessels
    causes the gas bubbles to into the blood circulatory system (gas embolism, hypoxia, boiling of blood and
    other liquids, especially at the height of 1900 m).
   A man feels the effect of increased atmospheric pressure in water during diver’s or caisson works.
   The most important is the fact if of quick increase of atmospheric pressure (hyperbaria) so the rupture of
    lung alveoli occurs and additional quantity of gases dissolves in blood and tissues (saturation). Nitrogen plays
    a key-role in breathing with the compressed air. The quantity of nitrogen in the body can sometimes increase,
    especially in the organs, which contain a lot of lipids (nervous system).
   The first manifestation is a light excitement, like euphoria, the next are the phenomena of narcosis and
    intoxication.
   Not only nitrogen is toxic, but also oxygen (hyperoxia) realizes its toxic effect a little later. The hemoglobin
    molecule is blocked by oxygen and loses its ability to carry out carbon dioxide. The result is that
    oxygemoglobin practically does not dissociate and carbon dioxide is not removed.
   Toxic effect of high concentration of oxygen is similar to the effect of radiation. In both cases the formation
    of free radicals and peroxides with strong exudative abilities causes affection of DNA and tissue enzymes.
   The antioxidant therapy must be used, such as tocopherols, glutathione, ubiquinone and others, which
    suppress free radical oxidation. Decompression can be used which is a method of returning of the man into
    the conditions of normal atmospheric pressure and the excretion of the excess quantity of dissolved gases
    via blood and lungs (desaturation).
Pathogenic influence of electric current




• Mechanism:
• Electric energy is transformed into:
• 1. Mechanical tearing off tissues and bones and even part of the body
• 2. Thermal – temperature in place of penetration may be 120 °C and
  more – than burns arise
• 3. Chemical – electrolysis may cause changes of biological potential of
  the different cells.
The effect of ionizing radiation
•   The rays of high energy (X- and γ rays), α and β-particles, proton possesses
    the ability to penetrate into the radiated environment and produce ionization.
The Effect of the Thermal Factors
 1. The effect of the high temperature (when the air
  temperature elevation varies from 33 °C to 37°C, it is
  equal to the body temperature) is the development of
  the overheating (local effect – burn), or the effect of
  the low temperature – hypothermia.
 2. Characterize overheating.
 There are two stages:

   1) Compensation stage, when normal temperature is
  preserved.
   2) Decompensation stage, when overtension of
  thermoregulation leads to its exhaustion.
 3. Describe hypothermia.
 The effect of the low temperature on the body may
  result in the decrease of the body temperature and the
  development of pathological condition – hypothermia.
  There are two stages of overcooling:
 1. Compensation stage is directed at limitation of the
  heat emission.
 2. Decompensation stage or hypothermia proper.
Crush Syndrome
 Crush syndrome (CS) is a variant of
    traumatic disease. The main pathogenic
    factors in CS are:
1) Pain syndrome
2) Intoxication
3) Psychoemotional stress
4) Hypovolemia
 Characterize the clinical course of
    crush syndrome.
 There are three periods in the clinical
    course of crush syndrome:
1. Early (to 3 days, with compression and
    decompression phases)
2. Intermediate (from 8 to 12 days) with the
    prominence of acute renal insufficiency
    (ARI)
3. Late (from 12 days to 1-2 months — the
    period of recovery with the prevalence of
    local syndromes.
Literature
   Basic:
1. General and clinical pathophysiology / Edited by Anatoliy V. Kubyshkin –
    Vinnytsia: Nova Knuha Publishers – 2011.
2. Pathophysiology, N.K. Symeonova. Kyiv, AUS medicine Publishing, 2010.
3. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/ Study
    guide for medical students and practitioners.-Odessa, 2003.
4. Essentials of Pathophysiology: Concepts of Altered Health States (Lippincott
    Williams & Wilkins), Trade paperback / Carol Mattson Porth, Kathryn J.
    Gaspard. – 2003.
 Additional:
5. Robbins basic pathology, 7/e / Kumar et al. – Indian reprint, 2004.
6. Pathological physiology / Yu.I. Bondarenko, M.R. Khara, V.V. Faifura, N. Ya.
    Potikha. ‑ Ternopil: Ukrmedkniga, 2006.
7. Pathophysiology, Concepts of Altered Health States, Carol Mattson Porth,
    Glenn Matfin.- New York, Milwaukee- 2009 p.
8. Stephen J. McPhee. Pathophysiology of Disease. An introduction to Clinical
    Medicine / Stephen J. McPhee, William F. Ganong // Lunge Medical
    Books/McGraw-Hill. – 5th edition. – 2006.
9. http://testcentr.org.ua/
10. http://kroktest.org.ua/kroki/krok-1/foreign-tests/examination-tests-or-booklets-
    foreign-students-englishstep-1
11. http://online.kroktest.org.ua/
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General teaching about disease

  • 2. Classroom Etiquette:  Turn off iPads and cell phones !  No tobacco use of any kind  Be considerate of others:  Take out what you bring in.  Talk to me, NOT your neighbor!  Remember for personal hygiene - cleanliness above all!  Do not ask for release of classes, you are able go to the dean’s office and student’s clinic!  NO:  Be Late (in case You are late - look above ↑ )  Plagiarism  Cheating  Allowing others to copy from you  Penalties can be severe !!!  REWORKS – every Monday at 4 p.m. (till last student)
  • 3. Terminology  Pathology – focus on physical changes in diseased organs and tissues  Pathophysiology – abnormal functioning of diseased organs and how it applies to medical treatment and patient care
  • 4. Pathological physiology is the science, which studies the general law fullness of disease genesis, development and the end. This is the science about the vital activity of sick organism. Pathological physiology is the study of the most common options of the disease genesis and development, while clinical sciences study specific items of disease prevention, diagnostics and treatment. Pathological physiology, as a science, solves the following problems:  illness essence establishment;  disease causes and it’s beginning conditions study;  illness development, display, course and the convalescence mechanisms separate explanation;  diseases prevention and cure general principles determination.
  • 5. The pathological physiology is related to the other sciences. The following connections are: a) to the sciences, which study illness causing environmental factors (physics, chemistry, biology, microbiology, the social sciences), they are necessary for etiology studying; b) to the sciences, which study the organism properties and its vital functions (cytology, embryology, histology, the normal physiology, biochemistry, immunology, genetics), they create a base for pathogenesis study; c) to general theoretic sciences, which study an the disease (pathological anatomy, pharmacology), in common with pathological physiology create a total picture of the illness; d) to the clinical sciences, helping to determine the basic etiological and pathogenic principles of disease prevent, diagnostics and cure. The clinic arises the problems and gives the necessary material for their solvation to pathophysiologists.
  • 6. The connect between the pathophysiology and other disciplines
  • 7. Methods of Pathophysiolog y 1. Clinical 2. Epidemiological 3. Anatomic 4. Experimental  The peculiarity of pathophysiological experiment is the reproducing of the experimental disease models upon laboratory animals with the purpose to establish the mechanisms of their genesis, development and in human organism.
  • 8. The experimental disease model is the artificial reproducing of disease up the laboratory animals, which has the same lines of the proper human disease. • Though an experiment up animals does not give us the full picture of the proper human disease, it enables to observe and to study the disease course the beginning to its completion, that is impossible in clinics. During the experiment one can control the environmental conditions, which influence upon the illness course and have the objective material for the scientific theories construction. • The experiment can be divided into the acute and the chronic one. • The acute experiment is based on the surgical intervention in animal organism. It examines the acute disorders in organism (shock, collapse, sharp breathing insufficiency, blood circulation insufficiency, etc). • The chronic experiment is a protracted one, shows the illness development dynamics. It is used for chronic diseases modeling (diabetes, atherosclerosis, arterial hypertension, ulcerous disease etc).
  • 9.  Pathological physiology consists of such parts: ► the general pathology and ► the pathophysiology of the organs and systems.  The general pathology unites such parts: ► nosology, ► pathogenic environmental factors action, ► inner factors role in pathology,  ► typical pathological processes, ► the typical metabolic disturbances.  The pathophysiology of organs and systems studies the general development of pathological processes in separate functional systems; the most widespread nosological forms are etiology and pathogenesis .
  • 10. The general nosology includes such notions: health disease pathological process pathological state pathological reactions
  • 11. Nosology ► Nosology (fr. Gk nosos, disease + logos, science) is a general science of diseases including the basic concepts and categories of pathology, classification and nomenclature of diseases, social aspects of pathology. ► Nosology deals with many problems: building basic scientific terms, used in medicine: Health and Disease, pathological processes, conditions, pathological reactions, stages of a disease, its complications, and other terms which are of medical importance. ► Development of nomenclature of diseases and their conditions. ► Building a classification of diseases. ► Laying the foundations for the general study of diseases. ► Developing a theoretical conception of medicine. ► Basic concepts of nosology: ► Health, disease, normal, pathological reaction, pathological process and pathological conditions.
  • 12. TERMINOLOGY • Etiology (fr. Gk aetia, reason + logos, science) is the science of causes and conditions of disease occurrence. Etiology studies general properties of pathogenic factors, basic categories of pathogenic factors, significance of conditions in occurrence of diseases, principles of etiotropic prophylaxis and etiotropic therapy. • Pathogenesis (fr. Gk pathos, disease + genesis, origin) is the science of mechanisms of development, course and outcome of diseases. The science of pathogenesis includes: mechanisms of stability of organism to the action of pathogenic factors, general mechanisms of development of diseases, mechanisms of recovery, mechanisms of dying, principles of pathogenetic prophylaxis and pathogenetic therapy. • Biological modeling is an artificial reproduction of disease processes in a living organism (in a cell, organ, entire organism).
  • 13. TERMINOLOGY • A pathological reaction (fr. Gk pathos, affliction, disease; Lat. re- - against, actio - action) is an organism response to extraordinary irritant, which is sometimes a symptom of disease. • A pathological process is a complex of pathological and protective- adaptative reactions as a response to a damaging effect of a pathological factor. • A typical pathological process is a pathological process developing in accordance with the same rules, irrespective of reasons and localization. • A pathological function (fr. Gk pathos, affliction, disease; Lat. functio, activity) is a disorder of function of a cell, tissue, organ, system of organs and vital activity of organism). • A pathological reflex (fr. Gk pathos, affliction, disease; Lat. reflexus, reflected) is a disorder of functional activity of organs, tissues or systems, occurred with participation of CNS in response to pathogenic irritation of receptors and manifested as pathological reactions of organism. • A pathological condition (status pathological) is a stable abnormality of organism functions, a sluggish pathological process or the consequence of an earlier suffered pathological process.
  • 14. Health is the condition of complete physical, psychic and social well- doing, but not only diseases or the physical defects absence (WHCO – World Health Care Organization). In doctor’s practical activity determination is used, according to which health is the condition of a norm. There is a question: what is the norm? There are two approaches to this notion determination: the statistic and the general physiologic one. According to the first one, the norm is the condition, which is the most frequently observed among people. According to the second one, the norm is the biological optimum of the organism functioning and development. The second determination reflects the scientific approach to the notion which is “a norm”. However this approach remains still unrealized because of our knowledge and possibilities limitation.
  • 15. Disease – loss of homeostasis, or when physical or mental capacities cannot be fully utilized (interuption, cessation or disorder in the function of an organ or system).  The disease is disturbance of human organism vital activity under the influence of extraordinary factors of external or inner environment which is characterized by lowering of capacity for work and adaptation with simultaneous mobilization of protective forces.
  • 16. • Stages of a Disease. 1. The latent period or incubation period of an infectious disease. The incubation period of a disease lasts from some hours to some days or years. The patient must be isolated or hospitalized. 2. Prodromal period of a disease. The patient develops generalized clinical symptoms of a disease (complaints of a headache, slight malaise, chills, rheumatic pains in his joints as well as muscular pains). The doctor can make a preliminary diagnosis in this period of disease development. 3. Dromal period of a disease. It is marked by all clinical characteristics of a disease. In the dromal period the patient develops all specific clinical symptoms. The doctor has to make the final, basic diagnosis in this period of disease development. 4. Outcome of a disease will be favorable or unfavorable. – recovery - complete or incomplete – recurrence – chronic disease –remission and exacerbation • Terminal state • preagonal state • agonal state • clinical death • biological death.
  • 17. The diseases endings are following: convalescence ( complete and incomplete), recurrence, into chronic form transition, the death.  The convalescence is the process, which conduces to the violations liquidation, caused by an disease, and normal relations with the environment  restoration, for human beings – foremost the ability to work restoration. The full convalescence is the state when all the disease signs disappear and organism restores its adaptation possibilities completely. When the convalescence is incomplete the disease consequences are expressed. They remain for a long time or forever. The convalescence is provided by the urgent (emergency) and lasting protectively-compensational reactions of the organism.  The remission is the temporal state improvement of the human being, which is displayed by the disease progressing slowing down or cessation, the partial reverse development or the disappearance of the pathological process clinical signs.  The recurrence is the new disease display after its seeming or incomplete cessation.  The complication is secondary as for reference to the disease pathological process.  The transition in the chronic form signifies that disease courses slowly with the protracted remission periods (months and even years). So, many diseases acquire chronic nature in old age (chronic pneumonia, chronic colitis).
  • 18. The terminal states are the boundary ones between life and death. This is also the dying, which include a few stages: pre-agony, agony, clinical death, biological death. ► The preagony is characterized by the diverse duration (during hours, days) of deep violations of the vitally important organism functions. The dyspnea, the decreasing of the arterial pressure, the darkening down of the consciousness, which are observed in this period. Gradually the pre-agony gets across in the agony. ► The agony is characterized by the gradual turning down of all organism functions. The agony lasts 2-4 minutes, sometimes more. ► The clinical death is such condition when all of the visible sparks of life have already disappeared (the breathing and the heart work are ceased, however the metabolism still continues). The life can be restored on this stage. ► The biological death is characterized by the irreversible changes in the organism. ► The reanimation of the organism includes number of measures which are directed foremost to blood circulation and breathing renewal: heart massage,  artificial lungs ventilation, heart defibrillation. The indirect heart massage is widely used for the renewal of blood circulation, it can be used at once after the clinical death setting in any conditions and even not by specialist. The artificial ventilation of the lungs also must be started as soon as possible. The heart fibrillation is observed in the terminal period ordinary. In such cases the electric defibrillation is used. A single digit to 6000 V removes the fibrillation and promotes the renewal of the blood circulation.
  • 19. Cause of a Disease • One of the most important and difficult questions is the problem of establishing the cause of a disease. The tactics of the physician and the success of treatment of various diseases depend on the correct solution of this problem. Pavlov believed that a problem of etiology is the least investigated problem of medicine. In the course of development of natural history the theory of etiology of diseases has been changing. Each etiological theory was influenced by the dominant ideas of the time it was formed at. The old theory could not account for new facts. There were two ways of doing research: either to deny the facts or to change theories interpreting them. • The ancient medicine gave rise to the idea of a causative agent as a major etiological factor. XVII –XVIII centuries witnessed the development of a new doctrine known as mechanical determinism.
  • 20. Theories •The mechanical determinism of XVII-XVIII centuries was of great significance for the development of the theory of pathology. Within a framework of mechanical determinism some basic methods of establishing causal connection (method of isolation, method of similarity, method of differences, method of attendant changes, method Louis Paster of remainder) were elaborated. These methods are still of great importance nowadays. • The important stage in the development of this scientific trend was elaboration of the theory of mechanical monocausalism. • The origin of this theory was prompted by discoveries of infectious pathology. Within a short period of time the causative agents of most widespread infectious diseases were discovered which was inspired by Paster’s idea that diseases may be caused by infectious agents. Many scientists overestimated the importance of microbes in the development of diseases.
  • 21. Theories • Monocausalism was most fully reflected in the conception of Genle - Kock: • A certain microbe causes a certain disease, it can be found neither in healthy people nor in people suffering from other diseases. • A microbe can be isolated in a pure culture. • Pure microbial culture will cause the disease whose causative agent it is supposed to be in experiment. • This conception was of great importance as it channeled the research into discovering numerous microbes. • However, there was some clinical evidence which contradicted this conception. Firstly, the study of severe epidemics revealed that not all people get infected and develop a disease. Nor all of those infected die. Secondly, there was experimental evidence that a hen which is not subject to anthrax in ordinary conditions dies if its legs are kept in cold water for a while. Thirdly, milkmaids that had had cowpox did not catch smallpox during epidemics. • Finally, in 1884 Lefler discovered the fact of carriage of bacilli. He found virulent streptococci and pneumococci on the mucous membranes of the pharynx and on the tonsils of healthy people.
  • 22. Theories Later a new theory of conditionalism gained popularity. The founder of that theory was Ferworn. He formulated five principles of this conception. 1. The first of them is as follows. There are no isolated and absolute things. All processes or states are conditioned by other processes or states. 2. There are no processes or states which are determined by a single factor. All processes or states are conditioned by a large number of factors (doctrine of multiple conditions). 3. Every process or state is unequivocally determined by the sum of their conditions 4. Every process or state is identical to the sum of their conditions. 5. All conditions of any process or state are equally significant. • Conditionalism is a subjective idealism theory. Microbes alone can not account for the origin of infectious processes. But we should not underestimate the role of microbes in this process.
  • 23. Theories • Another step in the development of the doctrine of etiology is constitutionalism. The founders of this theory believed that diseases may be caused by a constitution type. These types are as follows: normal, asthenic or hyperstenic constitution. Each type of constitution has its own peculiarities. People of asthenic constitution are subject to stomach ulcer and tuberculosis. People of hyperstenic constitution are likely to suffer from myocardial infarction or bronchial cancer. This theory is based on the theses of formal genetics and on genotype invariability. However, a genotype can change under the influence of many exogenous and endogenous factors. Therefore, this theory can not be considered true.
  • 24. Theories The next theory was elaborated by Zigmund Freud. This author distinguished three main systems in the psychic (mental) structure of a person: the conscious, the subconscious and the unconscious. The latter is the home for sexual instincts. • The conscious constantly suppresses these instincts. Freud believed that a daughter’s love for her father, a son’s love for his mother are manifestations of sexual instincts. Human consciousness constantly suppresses these sexual instincts. But having a high power charge they tend to struggle their way to consciousness. This results in the development of numerous diseases such as schizoprenia, epilepsy, neurosis, etc. • Zigmund Freud's conception had a great effect on the western medical science. It also gave rise to a new branch of medicine, i.e. psychosomatic medicine. The supporters of this branch of medical science suppose that diseases may be caused by psychological conflicts in childhood. Different pathological processes are conditioned by different stages of children’s development when disorders occur. • Under 6 months of age an infant seeks for his mother’s love and has a food instinct. Disorders at this age lead to bronchial asthma or ulcer. Under 3 years of age a child has an inclination for analysis. They often break their toys and other things. If parents forbid to do this a child gets aggressive and spasms of the muscular system occur. From 3 to 6 years a child develops a sense of self and sexual feelings. Disturbances at that age will result in hysteria and in various sexual disorders.
  • 25. Thus, we have outlined the main theories of etiology in medicine. Nowadays etiology is a theory of causes and conditions of a disease development. • A cause determines specificity and quality of the bodily reaction to a pathological process. A cause also determines connections and regularities of the processes. For example, tuberculosis is caused by Micobacterium tuberculosisIt is responsible for specific and morphological changes typical of it. • The following these underlie the modern idea of causality: • All natural phenomena have their own cause, there are no causeless phenomena. • The cause is material, it is independent of our existence. • The cause interacts with the organism. Changing the body, the cause changes itself. • The cause gives a new quality to a process. It is the cause that makes a pathological process special and unique. • Classification of causes: • Exogenous: physical, chemical, biological, psychic/mental and social. • Endogenous. • Conditions. • Psychic/mental conditions in childhood. • Urbanisation. • Industrialisation. • War. • Unemployment.
  • 26. The diseases classifications are based on the following criterias: • 1. The etiological classification is founded on the cause community for the diseases group. For example, there are the infectious and uninfectious diseases. According to the same principle one can group the diseases caused by an intoxication (food, professional), genes violations and chromosomal mutations (hereditary diseases) etc. • 2. The topography-anatomic classification is based on the organ principle: the cardiovasculars diseases, diseases kidneys, diseases of nervous system etc. It is comfortable for practice. Besides, it corresponds to the modern specialization of the medical help. It combines with the classification of the functional systems: blood system, digestive system, musculosceletal apparatus diseases etc. • 3. The age and sex disease classification. There are the children’s diseases, the senile age diseases. The female genitals diseases are studied by the gynecology. • 4. The ecological diseases classification proceeds from the human dwelling conditions: the air temperature, the atmospheric pressure, the sun illumination. • 5. The classification according to the pathogens commonness: allergic and inflammatory diseases, neoplasms, shock, hypoxia.
  • 27. The general etiology • The etiology is the learning of  disease beginning causes and conditions. The notions of causality and determinism are base of etiology. • A causality reflects an objectively existent phenomenas connection, when one phenomenon (cause) inevitably causes beginning of the other phenomenon (result) by the definite conditions. Any disease just like a phenomenon has its own cause. The beginning and the development of the disease are not by chance but subordinated to the definite lawfullness.
  • 28. Classification of etiological factors  They are exogenous (external) and endogenous (internal). The exogenous factors:  a) physical – mechanical influence, radiation, high and low temperature, electric current, overloading, zero-gravity and others  b) chemical – the inorganic and organic compound; c) biological – viruses, rickettsias, bacterias, Protozoas, helmints, Arthropodes  d) psychic – a word  e) social – society development level, traditions and others The endogenous factors:  heredity  constitution  age  sex  organism reactivity
  • 29. Categories of etiology Genetic disease– genes are responsible for a structural or functional defect Congenital disease– genetic information is intact, but the intrauterine environment interferes with normal development Acquired disease – disease is caused by factors encountered after birth (biological agents, physical forces, and chemical agents) Clinical manifestations – indications that the person is sick Symptoms – unobservable effects of a disease reported by the patient Signs – observable or measurable traits Syndrome - a characteristic combination of signs and symptoms associated with a particular disease.
  • 30. Pathogenesis - sequence of events in the of development of a disease Sequelae – lesions or impairments resulting from a disease Acute conditions – rapid onset, develop quickly, usually of short duration Chronic conditions – longer duration onset may be sudden or insidious Distribution of lesions may be: Local – confined to one area of the body Systemic – widely distributed throughout the body Within an organ damage can be: Focal if there are only one or more distinct sites of damage Diffuse if the damage is uniformly distributed Diagnosis – identification of the specific disease Therapy – the treatment of the disease to either effect a cure or reduce the patient’s signs and symptoms Prognosis – prediction of a disease’s outcome
  • 31. Risk Factors The risk factors are the factors combinations, the presence of which in people population statistically increases morbidity by definite diseases. The belonging of these or those conditions to the risk factors is determined by epidemiological methods, which envelop the large people contingent. So it was established, that the violation of blood plasma lipid composition, arterial hypertension, the age, belonging to male, obesity, hypodynamia, hereditary factors, stress are the atherosclerosis risk factors.
  • 32. Adaptation and compensation  The base of adaptation and compensation are the same mechanisms which are named protective -adaptation or protective-compensatory. The distinction between these notions: is adaptation develops in augmentation of the action intensity of usual factors environmental. The damage hasn’t happed yet, and the homeostasis indexes are coming to the extreme norm borders. The compensation develops in the action of the pathogenic factors when a damage takes place and the homeostasis indexes are beyond the extreme borders norms.
  • 33. Adaptation and compensation in disease development  1. The stage of immediate adaptation and compensation. The mobilization of existing mechanisms and reserves begins and as a result of loading on functioning system unit increases, its hyperfunction develops. On this stage the events develop according to such scheme: the action of pathogenic factors → the violation of homeostasis → the perception of homeostasis violation → regulatory centers → immediate protective reactions (specific and unspecific) → the hyperfunction of proper structures, supporting homeostasis.  2. The stage of the long duration adaptation and compensation. The augmentation of systems power, responsible for adaptation and compensation is its base. It is reached by the augmentation of the structures amount, providing a hyperfunction, so hypertrophy develops. The hyperfunction → violation of intracellular homeostasis → activation of genomes → decrease of the proteins synthesis → cell hypertrophy.
  • 34. The general pathogenesis • The pathogenesis is the study about the mechanisms of the development, the course and the end of disease. The pathogens studies everything taking place after the cause action. • It is necessary to mention the following questions in disease pathogenesis consideration: 1) the role of etiological factor in disease development; 2) the organism reactivity significance for the disease beginning and the course; 3) the significance of the general and local changes and their correlation; 4) the basic link of pathogens and causally-investigation intercourses; 5) the significance of functional and morphological changes and their correlation in disease; 6) the significance of nervous system functional changes for disease development. There are three variants of connections between a cause and a pathogens: 1) Etiological factor initiates the pathologic process and then disappears, so the pathogenesis develops without etiological factor (trauma, radiation). 2) The cause continues its action throughout all the period of the development of the disease (infectious disease), as consequence the etiological factor penetrates into pathogenesis, exist in it and influence it. 3) Persistence of the cause agent, which causes the disease, is delayed in organism (healthy bacilli-carrier).
  • 35. How does pathogenesis divide? (four periods of pathogenesis) • The pathogenesis is a new complicated process in the organism with the two quite opposite processes: • 1) "the measure against the disease" (by I.Pavlov) — it means the compensatory and protective reactions • 2) "pathologic process proper" • So, the pathogenesis is a unity of opposites, which always fight (law of dialectics). The doctor must find out pathologic process the proper and stimulate the protection. There are four stages of pathogenesis: • 1) latent period (incubation period of the infectious diseases); 2) prodromal one; 3) the period of expressed manifestations; 4) the outcome of the disease.
  • 36. Local and Systemic in Pathogenesis • The study of pathogenesis of diseases proved that hare are neither purely local nor purely systemic diseases. The effectiveness of treatment depends on the correct understanding of this idea. • All diseases are local and systemic at the same time, which determines the development of processes. Dental caries can be treated using a stopper. If caries results from a systemic disorder of mineral and albumin exchange it requires a general treatment. • The correlation between local and systemic changes must be timely considered. • A local process, for example, a furuncle can develop as a result of the impairment of defense mechanisms of the organism which limits this process and makes it local.
  • 37. Local and Systemic in Pathogenesis
  • 38. Causally-investigation Relations  The changes in organism which arise during disease development are in definite causally-investigation relations, it means that the same phenomenon of pathogens is the result of violations and cause of other. Such type of causally- investigation relations when the definite links  the pathogens over violation sequence bring to their heightening over so called “the vicious round ”. It supports itself the pathogens of the disease and redoubles its course. So, in pathogens of any shock lowering of arterial pressure has big significance that becomes cause of anoxaemia. The cerebral hypoxia brings to the oppression of vasomotor centre and greater lowering of arterial pressure (a circle locked).  The main link of pathogens is the process which is necessary for a development of all the rest. The liquidation of the main link in time brings to removal of pathological process as a whole. The main principle of pathogenetic diseases cure is founded on it. So, in diabetes mellitus the insulin lack is the main link of pathogens. Its liquidation (the introduction of hormone) brings to disappearance of  other displays (hyperglycemia, glucosuria, polydipsia, ketonemia, comas).  In  pathogens  specific and unspecific processes and mechanisms are always combined. The specific ones depend on the cause properties and determine the basic disease descriptions. A search of the specific signs lays in base of  diseases recognition (diagnostics).
  • 39. Vicious circle Causes and consequences constantly change their places. The cause (etiological factor) causes the pathologic reactions (process) and than these reactions return to the first agent (etiological factor) and intensify it. So "vicious circle" is formed m pathogenesis For example, if arterial pressure decrease it causes the hypoxia and than vasomotor center depresses. It leads to the prolonged decrease of arterial pressure.
  • 40. Nonspecific and Specific Signs  Every disease can have its signs that are typical of this disease only (for example, irradiation of the pain in angina pectoris), while other signs are typical of many diseases or even for all. This common nonspecific aspect of pathogenesis depends on the reactions of the organism developing in the course of evolution and is hereditary. There are five nonspecific reactions:  Parabiosis. This is stable, non-spreading excitation, which occurs in damaged excitable tissues. It is important in pathogenesis of some forms of cardiac blocade.  Dominant reaction. This is a condition of a stable rise of excitability of the group of nerve centers, which regulates the overall activities of the body. The dominating motivation gives rise to other dominants such as nutritional, sexual, etc.
  • 41. Negative effect of changes of atmospheric pressure  A man feels the effect of decreased atmospheric pressure during ascent on plane or in mountains, or the pilots flying in nonhermetically sealed cabin.  The pathologic changes, occurring in it, are caused by two main factors:  a) decrease of partial pressure of oxygen in inspired air;  b) decrease of atmospheric pressure (decompression).  The clinical signs of decompression syndrome are: pain in the ears and frontal sinuses because of expansion of air in these cavities, nasal bleeding, because of bursts of small vessels. Bursting of alveoli and vessels causes the gas bubbles to into the blood circulatory system (gas embolism, hypoxia, boiling of blood and other liquids, especially at the height of 1900 m).  A man feels the effect of increased atmospheric pressure in water during diver’s or caisson works.  The most important is the fact if of quick increase of atmospheric pressure (hyperbaria) so the rupture of lung alveoli occurs and additional quantity of gases dissolves in blood and tissues (saturation). Nitrogen plays a key-role in breathing with the compressed air. The quantity of nitrogen in the body can sometimes increase, especially in the organs, which contain a lot of lipids (nervous system).  The first manifestation is a light excitement, like euphoria, the next are the phenomena of narcosis and intoxication.  Not only nitrogen is toxic, but also oxygen (hyperoxia) realizes its toxic effect a little later. The hemoglobin molecule is blocked by oxygen and loses its ability to carry out carbon dioxide. The result is that oxygemoglobin practically does not dissociate and carbon dioxide is not removed.  Toxic effect of high concentration of oxygen is similar to the effect of radiation. In both cases the formation of free radicals and peroxides with strong exudative abilities causes affection of DNA and tissue enzymes.  The antioxidant therapy must be used, such as tocopherols, glutathione, ubiquinone and others, which suppress free radical oxidation. Decompression can be used which is a method of returning of the man into the conditions of normal atmospheric pressure and the excretion of the excess quantity of dissolved gases via blood and lungs (desaturation).
  • 42. Pathogenic influence of electric current • Mechanism: • Electric energy is transformed into: • 1. Mechanical tearing off tissues and bones and even part of the body • 2. Thermal – temperature in place of penetration may be 120 °C and more – than burns arise • 3. Chemical – electrolysis may cause changes of biological potential of the different cells.
  • 43. The effect of ionizing radiation • The rays of high energy (X- and γ rays), α and β-particles, proton possesses the ability to penetrate into the radiated environment and produce ionization.
  • 44. The Effect of the Thermal Factors 1. The effect of the high temperature (when the air temperature elevation varies from 33 °C to 37°C, it is equal to the body temperature) is the development of the overheating (local effect – burn), or the effect of the low temperature – hypothermia. 2. Characterize overheating.  There are two stages: 1) Compensation stage, when normal temperature is preserved. 2) Decompensation stage, when overtension of thermoregulation leads to its exhaustion. 3. Describe hypothermia.  The effect of the low temperature on the body may result in the decrease of the body temperature and the development of pathological condition – hypothermia. There are two stages of overcooling: 1. Compensation stage is directed at limitation of the heat emission. 2. Decompensation stage or hypothermia proper.
  • 45. Crush Syndrome  Crush syndrome (CS) is a variant of traumatic disease. The main pathogenic factors in CS are: 1) Pain syndrome 2) Intoxication 3) Psychoemotional stress 4) Hypovolemia  Characterize the clinical course of crush syndrome.  There are three periods in the clinical course of crush syndrome: 1. Early (to 3 days, with compression and decompression phases) 2. Intermediate (from 8 to 12 days) with the prominence of acute renal insufficiency (ARI) 3. Late (from 12 days to 1-2 months — the period of recovery with the prevalence of local syndromes.
  • 46. Literature  Basic: 1. General and clinical pathophysiology / Edited by Anatoliy V. Kubyshkin – Vinnytsia: Nova Knuha Publishers – 2011. 2. Pathophysiology, N.K. Symeonova. Kyiv, AUS medicine Publishing, 2010. 3. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/ Study guide for medical students and practitioners.-Odessa, 2003. 4. Essentials of Pathophysiology: Concepts of Altered Health States (Lippincott Williams & Wilkins), Trade paperback / Carol Mattson Porth, Kathryn J. Gaspard. – 2003.  Additional: 5. Robbins basic pathology, 7/e / Kumar et al. – Indian reprint, 2004. 6. Pathological physiology / Yu.I. Bondarenko, M.R. Khara, V.V. Faifura, N. Ya. Potikha. ‑ Ternopil: Ukrmedkniga, 2006. 7. Pathophysiology, Concepts of Altered Health States, Carol Mattson Porth, Glenn Matfin.- New York, Milwaukee- 2009 p. 8. Stephen J. McPhee. Pathophysiology of Disease. An introduction to Clinical Medicine / Stephen J. McPhee, William F. Ganong // Lunge Medical Books/McGraw-Hill. – 5th edition. – 2006. 9. http://testcentr.org.ua/ 10. http://kroktest.org.ua/kroki/krok-1/foreign-tests/examination-tests-or-booklets- foreign-students-englishstep-1 11. http://online.kroktest.org.ua/

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  1. Genetic - hemophilia