THE MINISTRY OF PUBLIC HEALTH OF UKRAINE
VINNITSIA NATIONAL MEDICAL UNIVERSITY
named after M.I.PIROGOV
EDUCATIONAL-METHODICAL RECOMMENDATION
FROM PATHOPHYSIOLOGY
FOR THE 3RD YEAR
MEDICAL FACULTY STUDENTS
Module N 1 GENERAL PATHOLOGY
Practical training N 2
TYPICAL PATHOLOGICALPROCESSES
TYPICAL DISORDERS OF METABOLISM
VINNITSIA - 2015
The manual from Pathophysiology is approved and confirmed for the introduction into the educational process at Pathophysiology department meeting.
Protocol N 1 from 30.08.2015
Сompilers: Head of Department N.A. Rikalo
as. O.Y. Guminska
as. S.G.Polinkevich
The manual is recommended for the foreign students of medical faculty (3rd course).
Thematic plan
Medical faculty
Local disorders of blood circulation (hyperemia, ischemia, stasis, thrombosis, embolism).Inflammation.
Disorder of heat exchange. Starvation.
Neoplasia.
Disorders of carbohydrate metabolism.
Disorders of water-electrolytes metabolism.
Disorders of acidic-basic state.
Practical training 2: “Typical pathological processes. Typical disorders of metabolism.” Test control for the semester.
Theme: “LOCAL DISORDERS OF BLOOD CIRCULATION”.
Actuality of theme.
Prevalence of local violations of circulation of blood, such as arterial and venous hyperemia, ischemia and stasis is very important. Their development is predefined violation of the neurohumoral regulation of local blood circulation. Disorders of local blood circulation need the detailed study, as they are the main link of pathogenesis of many pathological processes. Knowledges about general mechanisms of their development are needed for successful treatment and prophylaxis of the proper violations.
It is known that the system of blood circulation takes leading place in support of vital functions of an organism as the whole system.
Providing of necessary blood stream is a difficult process which depends on the adequate functioning of heart, integrity of vascular wall and balance between coagulative and anticoagulative systems of blood.
All known diseases are accompanied with disorders of blood stream.
Local disorders of blood circulation, such as thrombosis and embolism is one of the most frequent reasons of death (thromboembolism of cerebrum vessels, pulmonary artery). That is why knowledge of reasons, mechanisms of development and consequences of thromboembolism has a large significance for a practical doctor.
General purpose of the lesson.
To learn the reasons of arterial and venous hyperemia, ischemia, stasis origin, mechanisms of their development, manifestations, significance for an organism. To learn reasons, mechanisms of development, manifestations, significance of thrombosis and embolism for the organism.
For this it is necessary to know (the concrete purposes):
1. To know the arterial and venous hyperemia, ischemia, stasis definitions.
2. To know the reasons of origin and mechanisms of peripheral blood circulation disorders development.
3. To describe the basic manifestations of different of, explain the mechanisms of their development.
4. To explain the value of local blood circulation disorders for an organism.
5. To be able to make the arterial and venous hyperemia, ischemia at experiment.
6. To give determination of conceptions: "thrombosis", "embolism".
7. To be able to explain principal reasons of origin, mechanisms of thrombosis development.
8. To explain the consequences of thrombosis.
9. To be able to classify embolism by origin and localization.
10. To explain the mechanisms of different kind of embolisms development.
11. To explain the significance of thrombosis and embolism for the organism.
For realization of purposes of lesson it is necessary to have the base knowledges-skills:
1. Dividing of bloodstream into the functional parts (Normal Physiology Department).
2. The conception about the vessels of microcirculation (Normal Physiology Department).
3. Mechanisms of bloodstream regulation (Normal Physiology Department).
4. Structure and functions of endotelial cells, basal membrane (Histology department).
5. Structural and functional organization of the blood circulation system (Normal Physiology and Histology Departments).
6. View about central and peripheral blood circulation (Normal Physiology Department)
7. Conception about the hemostasis system (Normal Physiology Department)
8. Concept about the fibrinolytic system (Normal Physiology Department)
9. Thrombocytes functions (Normal Physiology Department)
The checking of primary level of knowledges.
Give the answers to the following questions:
1. Basic forms of local blood circulation disorders.
2. Arterial hyperemia, definition.
3. What are the reasons of arterial hyperemia development?
4. Types of arterial hyperemia.
5. Venous hyperemia, definition.
6. Reasons of venous hyperemia development.
7. Ischemia, definition.
8. Stasis, definition.
9. Types of ischemia?
10. Types of stasis?
11. Thrombosis, definition.
12. Basic factors which are promote thrombus formation (Virchow’s triad).
13. What are the phases of thrombus formation process?
14. Consequences of thrombosis? From what does it depend?
15. Embolism, definition.
16. Types of embolisms according to origin.
17. Types of embolisms according to localization.
18. Types of exogenous embolisms.
19. Types of endogenous embolisms.
Standards of answers at the theoretical questions of initial level of knowledges:
1. Arterial and venous hyperemia, ischemia, stasis, thrombosis, embolism.
2. Arterial hyperemia – it is increased blood supply through the organ or part of tissue against of increased blood inflow from the arteries.
3. Influence of physical, chemical and biological factors of external environment, multiplying loading on an organ or area of tissue, psychogenic influencing.
4. Types of arterial hyperemia:
1) Physiological (after intensive work of organ, reactive)
2) Pathological (neurogenic, metabolic)
5. Venous hyperemia – it is increased blood supply through the organ or part of tissue against of decreased blood outflow from the veins.
6. Reasons of venous hyperemia:
1) intravascular (obturation of veins by a thrombus or embolus);
2) extravascular (compression of veins by a tumour, scar, tourniquet, by the enlarged organ (for example, by a pregnant uterus) by an edema);
3) constitutional weakness of elastic apparatus of veins, reduced tone of muscle elements of their walls;
4) disorders of general hemodynamics (cardiac failure, diminishing of suction ability of thorax).
7. Ischemia - it is decreased blood supply through the organ or part of tissue against of decreasing or complete stoppage of blood inflow from the arteries.
8. Stasis – it is slowing-down and stoppage of blood flow in the capillaries, small arteries and veins.
9. Basic types of ischemia:
1) Compressive
2) Obturative
3) Angiospastic.
10. Basic variants of stasis:
1) Ischemic
2) Venous
3) True (capillary).
11. Thrombosis - is the vital formation on the internal surface of vessel wall blood clots which consist of its elements. These clots got the name thrombus.
12. 1) Damage of vascular wall; 2) Violation of coagulative and anticoagulative blood system (increase of coagulative system activity or decline of anticoagulative system activity; 3) Deceleration of blood flow.
13. Cellular and plasma.
14. Necrosis (infarcnion), aseptic and septic meltdown, tromboembolism, disseminated intravascular clotting (DIC).
15. Embolism – is transfer of foreign bodies which do not meet there in a norm by the blood or lymph current with the next complete or partial vessel obturation.
16. Exogenous and endogenous.
17. By localization: embolism of greater circulation, embolism of lesser circulation and embolism of portal vein system.
18. Exogenous types of embolisms: air, gas, bacterial, parasite, embolism by foreign bodies.
19. Endogenous types of embolisms: thromboembolism, fatty, tissue, embolism by amniotic fluid.
Theoretical questions at the base of which the execution of purpose types of activity is possible.
1. Classification of peripheral blood circulation disorders.
2. Arterial hyperemia, determination of conception. Kinds. Reasons, basic mechanisms of development. Manifestations. Significance for an organism.
3. Venous hyperemia, determination of conception. Reasons, basic mechanisms of development. Manifestations. Significance for an organism.
4. Ischemia, determination of conception. Kinds. Reasons. Mechanisms of development. Manifestations. Significance for an organism.
5. Stasis, determination of concept. Kinds. Reasons, mechanisms of development. Significance for an organism.
6. Thrombosis, determination of conception. Value of Virchow’s triad in the mechanism of thrombosis development.
7. Modern views about thrombosis pathogenesis.
8. Consequences of thrombosis.
9. Embolism, determination of conception. Types of embolisms. Reasons of their origin and mechanisms of development. Value for an organism.
Literature.
1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. – p. 54-66, 68-71
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.60-68
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin – Vinnytsia: Nova Knuha Publishers – 2011. – p. 105-121.
Testing according system “Krok-I”
Tests of an open database (2014)
A 54-year-old female was brought to the casualty department after a car accident. A traumatologist diagnosed her with multiple fractures of the lower extremities. What kind of embolism is most likely to develop in this case?
A. Fat
B. Tissue
C. Thromboembolism
D. Gaseous
E. Air
Tests of an open database (2013)
1. While playing volleyball a sportsman made a jump and landed on the outside edge of his foot. He felt acute pain in the talocrural joint, active movements are limited, passive movements are unlimited but painful. A bit later there appeared a swelling in the area of external ankle, the skin became red and warm. What type of peripheral circulation disturbance is the case?
A Arterial hyperemia
B Stasis
C Embolism
D Venous hyperemia
E Thrombosis
2. A patient with obliterating endarteritis underwent ganglionic sympathectomy. What type of arterial hyperaemia should have developed as a result of the surgery?
A Neuroparalytic
B Neurotonic
C Metabolic
D Functional
E Reactive
3. A 42 year old woman with neuralgia of trifacial nerve complains about periodical reddening of the right part of her face and neck, sense of warmth gush, increased skin sensitivity. These effects can be explained by the following type of arterial hyperemia:
A Neurotonic
B Neuroparalytic
C Metabolic
D Functional
E Reactive
4. A rabbit's nerve that innervates the right ear was cut and its right superior cervical ganglion was removed. Immediately after operation the temperature of ear skin was measured. It was revealed that the temperature of the rabbit's ear skin on the side of denervation was by 1,50C higher than on the opposite intact side. What of the following is the most probable
explanation of the above-mentioned effects?
A Arterial neuroparalytic hyperemia
B Arterial neurotopical hyperemia
C Atrerial hyperemia induced by metabolic factors
D Reactive arterial hyperemia
E Physiological arterial hyperemia
5. A patient with obliterating atherosclerosis underwent sympathectomy of femoral artery in the region of femoral trigone. What type of arterial hyperemia was induced by the operation?
A Neuroparalytic
B Reactive
C Metabolic
D Neurotonic
E Functional
6. Upper neck node of sympathetic trunk was removed from the rabbit on experiment. Reddening and increased temperature of the skin of head is observed. What form of peripheral circulation of the blood developed in the rabbit?
A Neuroparalytic arterial hyperemia
B Neurotonic arterial hyperemia
C Metabolic arterial hyperemia
D Venous hyperemia
E Stasis
Tests of an open database (2010)
1. Increase of blood viscosity, - impression of microvessels walls at capillaroscopy were founded in a patient with chronic heart failure. What of these violations is possible in this case?
A. Sludge-phenomenon
B. Thrombosis
C. Embolism
D. Arterial hyperemia
E. Venous hyperemia
2. While playing volleyball a sportsman jumped and then landed across the external edge of his foot. This caused acute pain in the talocrural articulation, active movements became limited, passive movements remained unlimited but painful. In the region of the external ankle a swelling appeared, the skin turned red and became warmer to the touch. What type of peripheral circulation disorder has developed in this case?
A. Embolism
B. Venous hyperaemia
C. Arterial hyperaemia
D. Thrombosis
E. Stasis
3. Postganglionic sympathectomy was made at a patient with obliterating endarteritis. What type of arterial hyperemia will arise up as a result of the conducted operation?
A. Neuroparalitic
В. Neurotonic
С. Metabolic
D. Working
Е. Reactive
4. Woman, 42 age old, with trigeminal nerve neuralgia complain of periodic redness of face and neck right half, sensation of hot flushes and increase of the skin sensitiveness. Development of what kind of arterial hyperemia is able to explain these phenomena?
A. Neuroparalitic
B. Neurotonic
С. Metabolic
D. Working
Е. Reactive
5. Nerve which innervate the rabbit right ear was cut. Measuring of ears skin temperature conducted after operation. Temperature of rabbit ear skin at the side of denervation higher than at the opposite intact side on 1,50С. What form of peripheral blood circulation disorders was developed at rabbit?
A. Neuroparalitic arterial hyperemia
B. Neurotonic arterial hyperemia
C. Physiological arterial hyperemia
D. Reactive arterial hyperemia
E. Metabolic arterial hyperemia
6. Student wasn’t able to give the right answer on exam. Redness of skin, feeling of heat and uncertainty of behavior developed at the student. What type of arterial hyperemia will arise up in this case?
A. Neurotonic
B. Neuroparalitic
C. Metabolic
D. Pathological
E. Reactive
7. Desympathisation of the femoral artery in the area of the femoral triangle was made in a patient with atherosclerosis. What type of arterial hyperemia will arise up as a result of the conducted operation?
A. Neuroparalitic
В. Neurotonic
С. Metabolic
D. Working
Е. Reactive
8. Puncture of abdominal cavity for the extraction of fluid was performed to a 45-year-old patient with diagnosis “cirrhosis of liver, ascites”. State of unconsciousness suddenly developed in the patient as a result of decrease in blood pressure after extraction of 5L of fluid. That was considered as a manifestation of brain blood circulation insufficiency. Which disorder of microcirculation occurs in this case?
A. Ischemia
B. Arterial hyperemia
C. Venous hyperemia
D. Thrombosis
E. Embolism
9. Course of atherosclerosis at a patient, 70 years old, was complicated by thrombosis of lower extremities, a gangrenous fingers of the left foot. Beginning of thrombosis development is associated with:
A. Transformation of fibrinogen into fibrin
B. Activation prothromboplastin
C. Transformation of prothrombin into thrombin
D. Adhesion, aggregation and agglutination of platelets
E. Reduced synthesis of heparin
10. Thrombocytopenia, reduction of fibrinogen in the blood, appearance of fibrin degradation products, appearance of petechial hemorrhages are marked at a patients, 43 years, on the base ofseptic. Specify the cause of these changes: