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General teaching about disease

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Page 1: General teaching about disease
Page 2: General teaching about disease

Classroom Etiquette:Classroom Etiquette:

Turn off iPads and cell phones !Turn off iPads and cell phones ! No tobacco use of any kind No tobacco use of any kind Be considerate of others: Be considerate of others: Take out what you bring in. Take out what you bring in. Talk to me, NOT your neighbor! Talk to me, NOT your neighbor! Remember for personal hygiene - cleanliness Remember for personal hygiene - cleanliness

above all!above all! Do not ask for release of classes, you are Do not ask for release of classes, you are

able go to the dean’s office and student’s clinic!able go to the dean’s office and student’s clinic! NO:NO:

Be Late (in case You are late - look above Be Late (in case You are late - look above ↑↑)) PlagiarismPlagiarism CheatingCheating Allowing others to copy from youAllowing others to copy from you

Penalties can be severe !!!Penalties can be severe !!! REWORKS – every Monday at 4 p.m. (till last student)REWORKS – every Monday at 4 p.m. (till last student)

Page 3: General teaching about disease

TerminologyTerminology PathologyPathology – focus on physical changes in diseased – focus on physical changes in diseased

organs and tissuesorgans and tissues PathophysiologyPathophysiology – abnormal functioning of – abnormal functioning of

diseased organs and how it applies to medical diseased organs and how it applies to medical treatment and patient caretreatment and patient care

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Pathological physiologyPathological physiology is the science, which studies the is the science, which studies the general  law fullness of  disease genesis, development and general  law fullness of  disease genesis, development and the end. the end.

This is the science about the vital activity of sick organism. This is the science about the vital activity of sick organism. Pathological physiologyPathological physiology is the study of the most common is the study of the most common

options of the disease genesis  and development, while options of the disease genesis  and development, while clinical sciences study specific items of disease prevention, clinical sciences study specific items of disease prevention, diagnostics and treatment. diagnostics and treatment.

Pathological physiologyPathological physiology, as a science, , as a science, solves the following solves the following problemsproblems: :

illness essence establishment; illness essence establishment; disease causes and it’s beginning conditions study;  disease causes and it’s beginning conditions study;  illness development, display, course and the convalescence illness development, display, course and the convalescence

mechanisms separate explanation; mechanisms separate explanation; diseases  prevention and cure general principles diseases  prevention and cure general principles

determination. determination.

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The pathological physiology is related to the other The pathological physiology is related to the other sciences. The following connections are: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.

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The connect between the pathophysiology The connect between the pathophysiology and other disciplinesand other disciplines

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Methods of Methods of PathophysiologyPathophysiology

1.1. Clinical Clinical2.2. Epidemiological Epidemiological3.3. Anatomic Anatomic4.4. Experimental Experimental The peculiarity of The peculiarity of pathophysiological pathophysiological

experimentexperiment is the reproducing of the is the reproducing of the experimental disease models upon experimental disease models upon laboratory animals with the purpose to laboratory animals with the purpose to establish the mechanisms of their genesis, establish the mechanisms of their genesis, development and in human organism.development and in human organism.

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• 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 experimentexperiment can be divided into the acuteacute and the chronicchronic 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).

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Pathological physiologyPathological physiology consists of such consists of such parts: parts:

► ► the general pathology and the general pathology and ►► the pathophysiology of the organs and systems. the pathophysiology of the organs and systems. The general pathology unites such parts: The general pathology unites such parts: ►► nosology, nosology, ►► pathogenic environmental factors action, pathogenic environmental factors action, ►► inner factors role in pathology,  inner factors role in pathology,  ►► typical pathological processes, typical pathological processes, ►► the typical metabolic disturbances.the typical metabolic disturbances. The The pathophysiologypathophysiology of organs and systems of organs and systems

studies the general development of pathological studies the general development of pathological processes in separate functional systems; the processes in separate functional systems; the most widespread nosological forms are most widespread nosological forms are etiologyetiology and and pathogenesispathogenesis..

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The general nosology The general nosology includes such notions:includes such notions:

healthhealthdiseasediseasepathological processpathological processpathological statepathological state pathological reactionspathological reactions

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NosologyNosology► NosologyNosology (fr. Gk (fr. Gk nososnosos, disease + , disease + logoslogos, science) is a general , science) is a general

science of diseases including the basic concepts and science of diseases including the basic concepts and categories of pathology, classification and nomenclature of categories of pathology, classification and nomenclature of diseases, social aspects of pathology.diseases, social aspects of pathology.

► NosologyNosology deals with many problems: building basic scientific deals with many problems: building basic scientific terms, used in medicine: Health and Disease, pathological terms, used in medicine: Health and Disease, pathological processes, conditions, pathological reactions, stages of a processes, conditions, pathological reactions, stages of a disease, its complications, and other terms which are of disease, its complications, and other terms which are of medical importance.medical importance.

► Development of nomenclature of diseases and their conditions.Development of nomenclature of diseases and their conditions.► Building a classification of diseases.Building a classification of diseases.► Laying the foundations for the general study of diseases.Laying the foundations for the general study of diseases.► Developing a theoretical conception of medicine.Developing a theoretical conception of medicine.► Basic concepts of nosology:Basic concepts of nosology:► Health, disease, normal, pathological reaction, pathological Health, disease, normal, pathological reaction, pathological

process and pathological conditions.process and pathological conditions.

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TERMINOLOGYTERMINOLOGY• EtiologyEtiology (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 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).

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TERMINOLOGYTERMINOLOGY• A pathological reactionpathological 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 processpathological process is a complex of pathological and protective-adaptative reactions as a response to a damaging effect of a pathological factor.

• A typical pathological processtypical pathological process is a pathological process developing in accordance with the same rules, irrespective of reasons and localization.

• A pathological functionpathological 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 reflexpathological 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 conditionpathological condition (status pathological) is a stable abnormality of organism functions, a sluggish pathological process or the consequence of an earlier suffered pathological process.

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In doctor’s practical activity determination is used, according In doctor’s practical activity determination is used, according to which health is the condition of a norm. There is a to which health is the condition of a norm. There is a question: what is the norm? question: what is the norm? There are two approaches to this notion determination: the There are two approaches to this notion determination: the statistic and the general physiologic one.statistic and the general physiologic one.According to the first one, the norm is the condition, which is According to the first one, the norm is the condition, which is the most frequently observed among people.the most frequently observed among people. According to the second one, the norm is the biological According to the second one, the norm is the biological optimum of the organism functioning and development. The optimum of the organism functioning and development. The second determination reflects the scientific approach to the second determination reflects the scientific approach to the notion which is “a norm”. However this approach remains notion which is “a norm”. However this approach remains still unrealized because of our knowledge and possibilities still unrealized because of our knowledge and possibilities limitation. limitation.

HealthHealth is the condition of complete is the condition of complete physical, psychic and social well-physical, psychic and social well-doing, but not only diseases or the doing, but not only diseases or the physical defects absence (WHCO – physical defects absence (WHCO – World Health Care Organization).World Health Care Organization).

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The diseaseThe disease is disturbance of human organism is disturbance of human organism vital activity under the influence of vital activity under the influence of extraordinary factors of external or inner extraordinary factors of external or inner environment which is characterized by lowering environment which is characterized by lowering of capacity for work and adaptation with of capacity for work and adaptation with simultaneous mobilization of protective forces.simultaneous mobilization of protective forces.

DiseaseDisease – loss of – loss of homeostasis, or when physical homeostasis, or when physical or mental capacities cannot be or mental capacities cannot be fully utilized (interuption, fully utilized (interuption, cessation or disorder in the cessation or disorder in the function of an organ or function of an organ or system).system).

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• 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. Dromal3. 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.

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The diseases endingsThe diseases endings are following: convalescence ( complete are following: convalescence ( complete and incomplete), recurrence, into chronic form transition, the and incomplete), recurrence, into chronic form transition, the death.death.

The convalescenceThe convalescence is the process, which conduces to the is the process, which conduces to the violations liquidation, caused by an disease, and normal relations violations liquidation, caused by an disease, and normal relations with the environment  restoration, for human beings – foremost with the environment  restoration, for human beings – foremost the ability to work restoration. The full convalescence is the state the ability to work restoration. The full convalescence is the state when all the disease signs disappear and organism restores its when all the disease signs disappear and organism restores its adaptation possibilities completely. When the convalescence is adaptation possibilities completely. When the convalescence is incomplete the disease consequences are expressed. They remain incomplete the disease consequences are expressed. They remain for a long time or forever. The convalescence is provided by the for a long time or forever. The convalescence is provided by the urgent (emergency) and lasting protectively-compensational urgent (emergency) and lasting protectively-compensational reactions of the organism.reactions of the organism.

The remissionThe remission is the temporal state improvement of the human is the temporal state improvement of the human being, which is displayed by the disease progressing slowing being, which is displayed by the disease progressing slowing down or cessation, the partial reverse development or the down or cessation, the partial reverse development or the disappearance of the pathological process clinical signs.disappearance of the pathological process clinical signs.

The recurrenceThe recurrence is the new disease display after its seeming or is the new disease display after its seeming or incomplete cessation.incomplete cessation.

The complicationThe complication is secondary as for reference to the disease is secondary as for reference to the disease pathological process.pathological process.

The transitionThe transition in the chronic form signifies that disease courses in the chronic form signifies that disease courses slowly with the protracted remission periods (months and even slowly with the protracted remission periods (months and even years). So, many diseases acquire chronic nature in old age years). So, many diseases acquire chronic nature in old age (chronic pneumonia, chronic colitis).(chronic pneumonia, chronic colitis).

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The terminal statesThe terminal states are the boundary ones between are the boundary ones between life and death. This is also the dying, which include a life and death. This is also the dying, which include a

few stages: pre-agony, agony, clinical death, few stages: pre-agony, agony, clinical death, biological death.biological death.

► The preagonyThe preagony is characterized by the diverse duration (during hours, is characterized by the diverse duration (during hours, days) of deep violations of the vitally important organism functions. The days) of deep violations of the vitally important organism functions. The dyspnea, the decreasing of the arterial pressure, the darkening down of dyspnea, the decreasing of the arterial pressure, the darkening down of the consciousness, which are observed in this period. Gradually the pre-the consciousness, which are observed in this period. Gradually the pre-agony gets across in the agony.agony gets across in the agony.

► The agonyThe agony is characterized by the gradual turning down of all organism is characterized by the gradual turning down of all organism functions. The agony lasts 2-4 minutes, sometimes more.functions. The agony lasts 2-4 minutes, sometimes more.

► The clinical deathThe clinical death is such condition when all of the visible sparks of life is such condition when all of the visible sparks of life have already disappeared (the breathing and the heart work are ceased, have already disappeared (the breathing and the heart work are ceased, however the metabolism still continues). The life can be restored on this however the metabolism still continues). The life can be restored on this stage.stage.

► The biological deathThe biological death is characterized by the irreversible changes in the is characterized by the irreversible changes in the organism.organism.

► The reanimationThe reanimation of the organism includes number of measures which of the organism includes number of measures which are directed foremost to blood circulation and breathing renewal: heart are directed foremost to blood circulation and breathing renewal: heart massage,  artificial lungs ventilation, heart defibrillation. The indirect massage,  artificial lungs ventilation, heart defibrillation. The indirect heart massage is widely used for the renewal of blood circulation, it can 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 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 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 started as soon as possible. The heart fibrillation is observed in the terminal period ordinary. In such cases the electric defibrillation is used. terminal period ordinary. In such cases the electric defibrillation is used. A single digit to 6000 V removes the fibrillation and promotes the A single digit to 6000 V removes the fibrillation and promotes the renewal of the blood circulation.renewal of the blood circulation.

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Cause of a DiseaseCause 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.

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TheoriesTheories

• 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.

•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 of remainder) were elaborated. These methods are still of great importance nowadays.

Louis Paster

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Theories• Monocausalism 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.

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TheoriesTheories

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.

Later a new theory of conditionalism gained popularity. The founder of that theory was Ferworn. He formulated five principles of this conception.

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TheoriesTheories• 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.

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TheoriesTheories

• 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.

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.

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• 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.

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The diseases classifications are The diseases classifications are based on the following criterias: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.

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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.

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Classification of etiological factors Classification of etiological factors They are They are exogenous (external) and endogenous exogenous (external) and endogenous

(internal).(internal). The exogenous factors:The exogenous factors: a)a) physicaphysical l – mechanical influence, radiation, high and – mechanical influence, radiation, high and

low low temperature, electric current, overloading, zero-temperature, electric current, overloading, zero-gravity gravity and others and others

b)b) chemicalchemical – the inorganic and organic compound; – the inorganic and organic compound; c) c) biological biological – viruses, rickettsias, bacterias, – viruses, rickettsias, bacterias, Protozoas, Protozoas, helmints, Arthropodes helmints, Arthropodes

d) d) psychicpsychic – a word – a word e)e) socialsocial – society development level, traditions and – society development level, traditions and

others others The endogenous factorsThe endogenous factors: : heredity heredity constitution constitution age age sex sex organism reactivityorganism reactivity

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Categories of etiologyCategories of etiologyGenetic diseaseGenetic disease– genes are responsible for a structural – genes are responsible for a structural or functional defector functional defectCongenital diseaseCongenital disease– genetic information is intact, but – genetic information is intact, but the intrauterine environment interferes with normal the intrauterine environment interferes with normal developmentdevelopmentAcquired diseaseAcquired disease – disease is caused by factors – disease is caused by factors encountered after birth (biological agents, physical encountered after birth (biological agents, physical forces, and chemical agents)forces, and chemical agents)Clinical manifestationsClinical manifestations – – indications that the person is indications that the person is sicksickSymptomsSymptoms – unobservable effects of a disease reported – unobservable effects of a disease reported by the patientby the patientSignsSigns – observable or measurable traits – observable or measurable traits SyndromeSyndrome - a characteristic combination of signs and - a characteristic combination of signs and symptoms associated with a particular disease.symptoms associated with a particular disease.

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PathogenesisPathogenesis - sequence of events in the of development of a disease - sequence of events in the of development of a diseaseSequelaeSequelae – lesions or impairments resulting from a disease – lesions or impairments resulting from a diseaseAcute conditionsAcute conditions – rapid onset, develop quickly, usually of short – rapid onset, develop quickly, usually of short

durationdurationChronic conditionsChronic conditions – longer duration onset may be sudden or – longer duration onset may be sudden or

insidiousinsidiousDistribution of lesions may be:Distribution of lesions may be:

LocalLocal – confined to one area of the body – confined to one area of the bodySystemicSystemic – widely distributed throughout the body – widely distributed throughout the body

Within an organ damage can be:Within an organ damage can be:FocalFocal if there are only one or more distinct sites of damage if there are only one or more distinct sites of damageDiffuseDiffuse if the damage is uniformly distributed if the damage is uniformly distributed

DiagnosisDiagnosis – identification of the specific disease – identification of the specific diseaseTherapyTherapy – the treatment of the disease to either effect a cure or – the treatment of the disease to either effect a cure or

reduce the patient’s signs and symptomsreduce the patient’s signs and symptomsPrognosisPrognosis – prediction of a disease’s outcome – prediction of a disease’s outcome

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Risk FactorsRisk FactorsThe 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.

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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.

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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.

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The general pathogenesis• The pathogenesis is the study about the mechanismsstudy 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 There are three variants of connections between a cause and a pathogens: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).

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How does pathogenesis divide? How does pathogenesis divide? (four periods of pathogenesis)(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.

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Local and Systemic in PathogenesisLocal 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.

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Local and Systemic in Local and Systemic in PathogenesisPathogenesis

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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).

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Vicious circleVicious circleCauses and consequences Causes and consequences constantly change their constantly change their places. The cause places. The cause (etiological factor) causes (etiological factor) causes the pathologic reactions the pathologic reactions (process) and than these (process) and than these reactions return to the first reactions return to the first agent (etiological factor) agent (etiological factor) and intensify it. So "and intensify it. So "vicious vicious circlecircle" is formed m " is formed m pathogenesis For example, pathogenesis For example, if arterial pressure decrease if arterial pressure decrease it causes the hypoxia and it causes the hypoxia and than vasomotor center than vasomotor center depresses. It leads to the depresses. It leads to the prolonged decrease of prolonged decrease of arterial pressure.arterial pressure.

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Nonspecific and Specific SignsNonspecific and Specific Signs Every disease can have its signs that are typical of this Every disease can have its signs that are typical of this

disease only (for example, irradiation of the pain in disease only (for example, irradiation of the pain in angina pectoris), while other signs are typical of many angina pectoris), while other signs are typical of many diseases or even for all. This common nonspecific diseases or even for all. This common nonspecific aspect of pathogenesis depends on the reactions of the aspect of pathogenesis depends on the reactions of the organism developing in the course of evolution and is organism developing in the course of evolution and is hereditary. There are five hereditary. There are five nonspecific reactionsnonspecific reactions::

ParabiosisParabiosis. This is stable, non-spreading excitation, . This is stable, non-spreading excitation, which occurs in damaged excitable tissues. It is which occurs in damaged excitable tissues. It is important in pathogenesis of some forms of cardiac important in pathogenesis of some forms of cardiac blocade.blocade.

Dominant reactionDominant reaction.. This is a condition of a stable rise of This is a condition of a stable rise of excitability of the group of nerve centers, which regulates excitability of the group of nerve centers, which regulates the overall activities of the body. The dominating the overall activities of the body. The dominating motivation gives rise to other dominants such as motivation gives rise to other dominants such as nutritional, sexual, etc.nutritional, sexual, etc.

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Negative effect of changes of atmospheric Negative effect of changes of atmospheric pressurepressure

A man feels the effect of decreased atmospheric pressure during ascent on plane or in A man feels the effect of decreased atmospheric pressure during ascent on plane or in mountains, or the pilots flying in nonhermetically sealed cabin.mountains, or the pilots flying in nonhermetically sealed cabin.

The pathologic changes, occurring in it, are caused by two main factors:The pathologic changes, occurring in it, are caused by two main factors: a) decrease of partial pressure of oxygen in inspired air;a) decrease of partial pressure of oxygen in inspired air; b) decrease of atmospheric pressure (decompression).b) decrease of atmospheric pressure (decompression). The clinical signs of decompression syndromeThe clinical signs of decompression syndrome are: pain in the ears and frontal sinuses are: pain in the ears and frontal sinuses

because of expansion of air in these cavities, nasal bleeding, because of bursts of small 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 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 circulatory system (gas embolism, hypoxia, boiling of blood and other liquids, especially at the height of 1900 m).at the height of 1900 m).

A man feels the effect of increased atmospheric pressure in water during diver’s or A man feels the effect of increased atmospheric pressure in water during diver’s or caisson works.caisson works.

The most important is the fact if of quick increase of atmospheric pressure (hyperbaria) 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 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. 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, The quantity of nitrogen in the body can sometimes increase, especially in the organs, which contain a lot of lipids (nervous system).which contain a lot of lipids (nervous system).

The first manifestation is a light excitement, like euphoria, the next are the phenomena The first manifestation is a light excitement, like euphoria, the next are the phenomena of narcosis and intoxication.of narcosis and intoxication.

Not only nitrogen is toxic, but also oxygen (hyperoxia) realizes its toxic effect a little 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 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. The result is that oxygemoglobin practically does not dissociate and carbon dioxide is not removed.carbon dioxide is not removed.

Toxic effect of high concentration of oxygen is similar to the effect of radiation. In both 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 cases the formation of free radicals and peroxides with strong exudative abilities causes affection of DNA and tissue enzymes.affection of DNA and tissue enzymes.

The antioxidant therapy must be used, such as tocopherols, glutathione, ubiquinone and 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 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 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 the excretion of the excess quantity of dissolved gases via blood and lungs (desaturation).(desaturation).

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Pathogenic influence of electric currentPathogenic 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.

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The effect of ionizing radiationThe 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.

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The Effect of the Thermal FactorsThe Effect of the Thermal Factors 1. 1. The effect of the high temperature (when the air The effect of the high temperature (when the air

temperature elevation varies from 33 °C to 37°C, it is temperature elevation varies from 33 °C to 37°C, it is equal to the body temperature) is the development of equal to the body temperature) is the development of the overheating (local effect – burn), or the effect of the the overheating (local effect – burn), or the effect of the low temperature – low temperature – hypothermiahypothermia..

2.2. Characterize overheating.Characterize overheating. There are two stages:There are two stages: 1) 1) Compensation stageCompensation stage, when normal temperature is , when normal temperature is

preserved.preserved. 2) 2) Decompensation stageDecompensation stage, when overtension of , when overtension of

thermoregulation leads to its exhaustion.thermoregulation leads to its exhaustion. 3. Describe hypothermia.3. Describe hypothermia. The effect of the low temperature on the body may result The effect of the low temperature on the body may result

in the decrease of the body temperature and the in the decrease of the body temperature and the development of pathological condition – hypothermia. development of pathological condition – hypothermia. There are two stages of overcooling:There are two stages of overcooling:

1. Compensation stage is directed at limitation of the heat 1. Compensation stage is directed at limitation of the heat emission.emission.

2. Decompensation stage or hypothermia proper.2. Decompensation stage or hypothermia proper.

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Crush SyndromeCrush Syndrome Crush syndrome (CS)Crush syndrome (CS) is a variant of is a variant of

traumatic disease. The main pathogenic traumatic disease. The main pathogenic factors in CS are:factors in CS are:

1) Pain syndrome1) Pain syndrome2) Intoxication2) Intoxication3) Psychoemotional stress3) Psychoemotional stress4) Hypovolemia 4) Hypovolemia Characterize the clinical course of Characterize the clinical course of

crush syndrome.crush syndrome. There are There are three periodsthree periods in the clinical in the clinical

course of crush syndrome:course of crush syndrome:1. 1. EarlyEarly (to 3 days, with compression and (to 3 days, with compression and

decompression phases)decompression phases)2. 2. Intermediate Intermediate (from 8 to 12 days) with the (from 8 to 12 days) with the

prominence of acute renal insufficiency prominence of acute renal insufficiency (ARI)(ARI)

3. 3. Late Late (from 12 days to 1-2 months — the (from 12 days to 1-2 months — the period of recovery with the prevalence period of recovery with the prevalence of local syndromes.of local syndromes.

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LiteratureLiterature Basic:Basic:1. 1. General and clinical pathophysiologyGeneral and clinical pathophysiology / / Edited by Anatoliy VEdited by Anatoliy V. . KubyshkinKubyshkin

– – VinnytsiaVinnytsia: : Nova Knuha PublishersNova Knuha Publishers – 2011. – 2011. 2. Pathophysiology, N.K. Symeonova. Kyiv, AUS medicine Publishing, 2. Pathophysiology, N.K. Symeonova. Kyiv, AUS medicine Publishing,

2010.2010.3. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/ 3. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/

Study guide for medical students and practitioners.-Odessa, 2003.Study guide for medical students and practitioners.-Odessa, 2003.4. Essentials of Pathophysiology: Concepts of Altered Health States 4. Essentials of Pathophysiology: Concepts of Altered Health States

(Lippincott Williams & Wilkins), Trade paperback (Lippincott Williams & Wilkins), Trade paperback / / Carol Mattson Carol Mattson Porth, Kathryn J. Gaspard. Porth, Kathryn J. Gaspard. – – 2003. 2003.

Additional:Additional:5. Robbins basic pathology, 7/e / Kumar et al. – Indian reprint, 2004. 5. Robbins basic pathology, 7/e / Kumar et al. – Indian reprint, 2004. 6. 6. Pathological physiology / Yu.I. Bondarenko, M.R. Khara, V.V. Faifura, N. Pathological physiology / Yu.I. Bondarenko, M.R. Khara, V.V. Faifura, N.

Ya. Potikha. ‑ Ternopil: Ukrmedkniga, 2006. Ya. Potikha. ‑ Ternopil: Ukrmedkniga, 2006. 7. Pathophysiology, Concepts of Altered Health States, Carol Mattson 7. Pathophysiology, Concepts of Altered Health States, Carol Mattson

Porth, Glenn Matfin.- New York, Milwaukee- 2009 p. Porth, Glenn Matfin.- New York, Milwaukee- 2009 p. 8. Stephen J. McPhee. Pathophysiology of Disease. An introduction to 8. Stephen J. McPhee. Pathophysiology of Disease. An introduction to

Clinical Medicine / Stephen J. McPhee, William F. Ganong // Lunge Clinical Medicine / Stephen J. McPhee, William F. Ganong // Lunge Medical Books/McGraw-Hill. – 5th edition. – 2006. Medical Books/McGraw-Hill. – 5th edition. – 2006.

9. 9. http://http://testcentr.org.uatestcentr.org.ua//10. 10. http://kroktest.org.ua/kroki/krok-1/foreign-tests/examination-tests-or-http://kroktest.org.ua/kroki/krok-1/foreign-tests/examination-tests-or-

booklets-foreign-students-englishstep-1booklets-foreign-students-englishstep-111. 11. http://online.kroktest.org.ua/http://online.kroktest.org.ua/

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