THE MINISTRY OF PUBLIC HEALTH OF UKRAINE

VINNITSIA NATIONAL MEDICAL UNIVERSITY

named after M.I.PIROGOV

METHODICAL RECOMMENDATION

FOR MEDICAL FACULTY STUDENTS

FROM PATHOPHYSIOLOGY

Module N 1GENERAL PATHOLOGY

Practical training N 1GENERAL NOSOLOGY

VINNITSIA - 2011

The manual from Pathophysiology is approved and confirmed for the introduction into the educational process at Pathophysiology department meeting.

Protocol N 1from 30.08.2011

Сompilers:N.A. Rikalo

A.S. Grytsenko

O.Y. Guminska

The manual is recommended for the foreign students of medical faculty (3rd course).

THEMATIC PLAN OF PRACTICAL LESSONS:

Lesson 1 «Subjectandtasksofpathophysiology. Methods of pathophysiological investigations. Hystorical aspects of pathophysiology formation».

Lesson 2 «Generalnosology: general study about disease, etiology, pathogenesis»

Lesson 3 «Reactivity. Resistance. Immunological reactivity. Their role in pathology»

Lesson 4 «Role of constitution and heredity in pathology»

Lesson 5 «Pathogenic action of external environment factors (mechanical factor, physical factors: ionizing radiation, electric current, high and barometric pressure)»

Lesson 6 «Pathogenic action of external environment factors (chemical, biological, psychical and social factors).»

Lesson 7 «Allergy.»

Lesson 8 Practical training: “General nosology.Pathogenic action of external environment factors. Role of internal factors in pathology. Allergy.”

Theme 1: "SUBJECTANDTASKSOFPAHOPHYSIOLOGY. METHODS OF PATHOPHYSIOLOGICAL INVESTIGATIONS. MAIN STAGES OF PATHOPHYSIOLOGY AS A SCIENCE DEVELOPMENT".

Actuality of the theme.

The question of regulation of function at diseased organism – it is one of central questions in the general pathology. It serves the base to study and understanding the mechanism of disorders of function at different type of pathology. The knowledge of these mechanisms is of great importance for physician at choice of the methods of the diagnostics and pathogenic therapy of diseases.

General purpose of the lesson.

Learn the principles of modeling of the pathological processes. Show the regulation of breathing in condition of pathology.

For this it is necessary to know (the concrete purposes):

  1. To master the elementary skills of planning and carrying out the experiments on laboratory animals.
  2. To be able to draw up a protocol of study, analyze, process, summarize extracted results and make the conclusions.
  3. To fall into a, what is the subject of pathophysiology, pathophysiology tasks, significance of pathophysiology for the future specialist.
  4. To know, what is the physiological regulation of functions, what are the mechanisms of it.
  5. To estimate the significance of modern methods of investigations (experimental and clonocal) for pathophysiology.

For realization of purposes of lesson it is necessary to have the base knowledges-skills.

1.To know the methods of the empirical cognition: scientific observation, scientific experiment, empirical modeling (the department of the social sciences - discipline - philosophy).

2.To have a notion about the main rules of bioethics (the department of the social sciences - discipline - philosophy).

3.To reveal the mechanisms of neuro-reflector regulation of the external breathing (the department of normal physiology).

4.To explain at concrete examples the mechanisms of humoral regulation of external breathing (the department of normal physiology).

5.To reveal the mechanisms neurohumoral regulation of external breathing (the department of normal physiology).

6.To reveal the role a reflexes from the receptors of the mucous shell of the upper respiratory ways at regulation of the external breathing (the department of normal physiology).

The checking of primary level of knowledges.

Give the answers to the following questions:

1.How is realized the mechanisms of neuro-reflector regulation of external breathing?

2.How is realized the mechanisms of humoral regulation of external breathing.

3.How is realized the mechanisms of neuro-humoral regulation of external breathing.

4.Significance of the reflexes from receptors of the mucous shell of the upper respiratory ways at regulation of the external breathing.

5.The modern beliefs about respiratory centre.

6.The role of hydrogen at regulation of the external breathing.

7.The role CO2 at regulation of the external breathing.

8.The direct indexes of efficiency of the external breathing.

Theoretical questions, at the base of which the execution of purpose types of activity is possible.

1. Place of pathophysiology at the system of future doctors preparation.

2. Pathophysiology as a subject, its component parts: general pathology, pathophysiology of organs and systems.

3. Place of pathophysiology in the system of medical knowledge.

4. Subject of pathophysiology, tasks, objectives. Relationships with other disciplines.

5. Clinical pathophysiology.

6. The role of the achievements of molecular biology, genetics, biochemistry, physiology, immunology and other sciences in the development of modern pathophysiology.

7. Values of pathophysiology for clinical and preventive medicine.

8. Methods of pathophysiology.

9. Experimental modeling of pathological processes (disease) - the main method of pathophysiology - its possibilities and limitations. Experimental models of disease.

10. Modern methods of the experiment, the rules of work with experimental animals.

11. Experimental therapy.

12. Methods of clinical pathophysiology.

13. History of pathophysiology. The value of research works of K. Bernard, R. Virchow, J.Konheyma, Mechnikov, V. Pashutina, H. Selye and other prominent researchers.

14. Patriotic School of pathophysiology (N.A. Hrzhonschevskyy, V.V. Pidvisockyy, V.K. Lindemann, O.O. Bogomolets, M.M. Syrotynin, O.V. Reprov, D.O. Alpern, V.V. Voronin, M.N. Zaikov).

15. Research School of pathophysiology, the main directions of their activities.

16. Regulation of functions in health and pathology.

Literature is necessary for studying of the theoretical questions.

  1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. – P.5-7.
  2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р.3-10.

After adopting the theoretical questions students learn the practical part of lesson.

Practical work: «REGULATION OF FUNCTIONS IN PATHOLOGICAL PROCESSES».

Object of work: to show how respiratory regulation occurs in the case of the stricture of the airways and effect of the chemical irritans.

Description of experiment:The work is of demonstration type with the assistance of the students.

Each subgroup carries out an acute experiment with a rabit. The rabit is tied to the bench. The graphic recording of the initial respiration is performed on the tape measure of the kimograph with the help of the cuff applied to the thoracic cavity and connected by means of a rubber tube with a capcule of Mareae.

Experiment 1. Cause incomplete asphyxia by partial clamping of the trachea lumen. The recording of respiration and its analysis are carried out in this condition.

Conclusion:______

Experiment 2. For 15 sec to allow the rabit to breath with ammonia vapour and repeat the procedure in some minutes. To record respiration in this condition.

Conclusion:______

Experiment 3. Inject 0,5 ml of 0,1n solution of lactic acid into the lateral vein of the rabbit's ear. To record respiration in this condition. To make the analysis. To make the conclusions.

Conclusion:______

Experiment 4. Cause a full asphyxia claming the trachea. To study the development of the stages of asphyxia averting the animal from death.

Looked after development of stages of asphyxia:

1. Stage of excitation:

1) inspiratory dyspnea

2) expiratory dyspnea

2. Stage of braking:

3) Gasping-breathing, apnoea

Conclusion:____________

Situational task:

The foreign bodey is diagnosed in the larynxof a child. Objectively: the skin is cyanotic, the puls is rapid. What is the type of breathing that develops at this pathology?

______

Theme 2: " GENERAL STUDY ABOUT NOSOLOGY, ETIOLOGY AND PATHOGENESIS (the SEMINAR)".

Actuality of the theme.

Teaching about disease, or the general nosology (from greek “nosos” - a disease), belongs to belongs to the most old problem of medicine since. States of health and disease, as a rule, are interleaved and go one in another often without observable borders. For physician it is important to have general criteria, which gave him possibility faultless to distinguish health from disease.

Study about etiology or reason and condition of the development of the diseases, belongs to the oldest problem of medicine since because the first question, with which the physician is confronted at examination of sick, concerns its reasons. Find the reason a disease – it means to find the way to its treatment and preventive maintenance. However, this question is not from lights often. Special etiology studies the concrete reasons and condition of the arising the separate diseases.

Thereby, teaching about reason of the origin disease (etiology) is natural-scientific base one of the most important principle of medicine - its preventive directivity.

Studies about pathogenesis belong to the most actual problems of modern medicine. In fact only understanding general mechanism of development, motion and outcomes of diseases, it is possible to consider one a «thinking» doctor.

The sequence of changes is determined in an organism for every disease, cause-effective relations appear between different structural, metabolic and functional changes are determined at the same time. In other words factors which assist subsequent development of illness are determined.

The analysis of pathogenesis requires the clear understanding of role of etiologic factor in pathogenesis, and also correlation between general and local, structural and functional. Understanding of cause-effect relations and ability to see and select the «main link» of pathogenesis will allow the doctor of any profession to liquidate a pathological process and accelerate the offensive of favorable consequences of illness.

General purpose of the lesson.

  1. To know how to define biological and social essence of disease, the general regularities of dynamic of its development.
  2. To learn the role of the reasons and conditions in development of disease.
  3. To learn the general conceptions of pathogenesis, to interpret the mechanisms of development of pathological processes correctly.

For this it is necessary to know (the concrete purposes):

1. Explain the basic concepts of general nosology: health, disease, pathological process, typical pathological process, pathological reaction, pathological condition, etiology, pathogenesis.

2. Explain the basic concepts of etiology: causal factors, risk factors, and conditions of disease development.

3. Analyze various options for the cause-effective relationships in pathogenesis.

4. Analyze of pathological phenomena in the pathogenesis: adaptive-compensatory, general and local, specific and nonspecific, leading to main link of pathogenesis.

5. Evaluate the importance of modern methods of research (experimental and clinical) for the pathophysiology.

For realization of purposes of lesson it is necessary to have the base knowledges-skills.

1.To have a notion about correlation the weltanschauung and philosophy (the world, its structure, types) (department of the social sciences - discipline – philosophy).

2.To know philosophy of the Ancient East, China, Greece, Rome, Middle Ages and Renaissance (department of the social sciences - discipline – philosophy).

3.To be aware of the teaching of dialectical materialism. Have a notion about dialectics and its alternative (department of the social sciences - discipline – philosophy).

4.To know the philosophical conception of Z. Freud (department of the social sciences - discipline – philosophy).

5.To know the main philosophical categories: thing, characteristic, attitude, reason and effect, single and the general, necessities and casual, reality and possibility, contents and the form, essence and phenomena, system, element, structure and function (department of the social sciences - discipline – philosophy).

6.To have a conception about problem of the person in philosophy (the psyche and consciousness; biological, social and spiritual at person) (department of the social sciences - discipline – philosophy).

7.To have a notion about such philosophical conceptions, as: matter, motion, space and time (department of the social sciences - discipline – philosophy).

8.To have a notion about general-logical methods: abstracting, analysis and syntheses, induction and deduction, comparison and analogy (department of the social sciences - discipline – philosophy).

9.To know the methods of the empirical cognition: scientific observation, scientific experiment, empirical modeling (department of the social sciences - discipline – philosophy).

10.To have a conception about relationship of philosophy and medicine (the theories of the diseases to civilizations, ecological concepts) (department of the social sciences - discipline – philosophy).

11.To have a notion about philosophical problem of the life and death (department of the social sciences - discipline – philosophy).

12.To have a notion about the main rule of bioethics (department of the social sciences - discipline – philosophy).

Information required for renewing the base knowledges it is possible to find at the following textbook:

  1. Lectures from the philosophy course.

Check primary level of knowledge.

Give the answers to the following questions:

  1. Name the main history directions of development of the teaching about disease.
  2. Name the factors, from which the different looks at disease on different stage of mankind development are depending on.
  3. Hippocrates contribution at development of the general teaching about a disease.
  4. Characterize the humoral and the solidary direction.
  5. Galen contribution at development of the general teaching about disease.
  6. Avicenna contribution at development of the general teaching about disease.
  7. Paracelsus contribution at development of the general teaching about disease.
  8. Characterize the jatrochemical and the jatrophysical direction.
  9. R. Virhov contribution at development of the general teaching about disease.
  10. Formulate the main positions of cellular pathology of Virhov.
  11. Name positive and negative importance of cellular pathology of Virhov.
  12. Give definition of the conception "health".
  13. Give definition of the conception "disease".
  14. Give the definition of the conception "pathological process" (cite an example).
  15. Give the definition of the conception "pathological reaction" (cite an example).
  16. Give the definition of the conception "pathological state".
  17. Give the definition of the conception "typical pathological process" (cite an example).
  18. Principles of classifications of the diseases (cite an example).
  19. Name the periods of disease and give the feature of each period.
  20. Name the outcomes of the diseases.
  21. Give the definition of the conception "clinical death".
  22. Give the definition of the conception "biological death".
  23. Give the definition of the conception "social death".
  24. Give pathophysiologycal characteristic of the terminal states.
  25. Name the factors, from which duration of clinical death depends.
  26. Name the pathophysiologycal principles of reanimations
  27. Give the definition of conception "etiology".
  28. Name the main stages of the development of the teaching about etiology at pathology.
  29. What is the monocausalism? Explain the reasons of origin this direction in medicine?
  30. Significance of monocausalism in the development of the general studying about etiology.
  31. What is the conditionalism?
  32. Significance of conditionalism in the development of the general studying about etiology.
  33. What is the constitutionalism?
  34. Significance of constitutionalism in the development of the general studying about etiology.
  35. Give the definition of psychosomatic direction.
  36. 1Significance of psychosomatic direction in the development of the general studying about etiology.
  37. What is the philosophical base of general etiology?
  38. 1What is a methodological base of general etiology?
  39. Name the main positions of dialectics-materialistic determinism.
  40. Modern understanding of causality at pathology.
  41. Role of the conditions at arising of the diseases. Classification of conditions.
  42. Notion about mono- and polyetiologic diseases.
  43. Classification of etiological factor.
  44. What is the "risk factors"? Cite an example.
  45. Significance of "risk factors" at development of the diseases.
  46. Significance of the general studying about etiology for theoretical and practical medicine.
  47. Give definition of concept «pathogenesis».
  48. Explain the role of etiologic factor in pathogenesis (to make examples).
  49. Name the variants of interaction factor with an organism in time.
  50. Give description of role of structural and functional changes in pathogenesis.
  51. Give description correlation between “general” and “local” in a pathological process.
  52. What is “main link” of pathogenesis?
  53. Name the types of cause-effect relations.
  54. Give definition of conception «Vicious circle» in pathogenesis.
  55. Make an example of direct type of cause-effect relations.
  56. Make an example of cause-effect relations on the type of «convergence».
  57. Make an example of cause-effect relations on the type of «divergence».
  58. Make an example of cause-effect relations on the type of «vicious circle».
  59. Significance of common studies about pathogenesis.

Theoretical questions, at the base of which the execution of purpose types of activity is possible.

1. Basic concepts of nosology: "health", "norm", "disease", "pathologic process", "pathological condition", "pathological reaction."

2. Disease as a biological, medical and social problem.

3. Abstract and concrete in the concept of "disease".

4. Unity of destructive and protective in the disease.

5. Principles of classification of diseases, the WHO classification.

6. Basic patterns and periods of diseases.

7. Kind of outcomes of diseases. Remission, relapse, complications.

8. The concept of terminal states (preagony, agony, clinical death), and biological death (definition, features).

9. Pathophysiological basis of reanimation.

10. Main directions of study about the disease: humoral (Hippocrates), solidary (Democritus), cellular pathology (R. Virkhov).

11. The development of these areas today.

Theme of reports:

  1. Hyperbaric oxygenation, it’s using in medicine.
  2. Social death as physician-social problem of mankind.
  3. Adaptation, compensation. Mechanisms of immediate and long duration adaptation.
  4. Role of Virchov in development of study about pathogenesis. Positive and negative value of cellular theory.
  5. Adaptation, compensation. Mechanisms of immediate and long duration adaptation.
  6. Role of Virchov in development of study about pathogenesis. Positive and negative value of cellular theory.

Literature is necessary for studying of the theoretical questions.

  1. General nosology. Manuals for the students. – Vinnitsia, 2007.
  2. Handbook of general and Clinical Pathophysiology/ Edited by prof. A.V.Kubyshkin, CSMU, 2005.
  3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005.– Р.10-12
  4. Lecture’s materials.

Checking of the final level of knowleges.

“KROK-1” open database 2010

1. Insufficiency of the mitral valve was founded at man who 12 years ago suffered from rheumatic myocardites.Investigations have shown that the inflammatory process is absent, minute volume of circulation is sufficient. Name the nition of general nosology.

  1. Pathological state
  2. Pathological reaction
  3. Disease process
  4. Typical pathological process
  5. Compensating reaction

2. Atrophy of bone marked in the patient after the removal of teeth. This is an example of:

  1. Pathological condition
  2. Pathological reaction
  3. Pathological process
  4. Structural adaptation
  5. Disease

2006-2009

1. A 50-year –old man has a stomach ulcer. After the treatment digestion become to normal, pain dissapiared, and his mood improved. However, in a couple of weeks the patient developed pain in epigastric region, heartburn and acd belching. How this situation might be interpreted?

  1. Disease relaps
  2. Remission period
  3. Terminal status
  4. Premonitory period
  5. Latent period

2. A 12-year-old boy after coming home from the school began to complaint of headache, nausea, chill, periodic muscle pain, loss of appetite, and fatigue. What disease period can show such signs?