Pathophysiology

Constitutionalism.
Constitutionalism - for at total of etiology, was based on the formal genetics of the immutability of the genotype and genetic predetermination diseases, the occurrence of which is associated with a flawed constitution. Recognizing insolvency of the causal direction of the etiology, some pathologists have come to the conclusion that the decisive factor in causing disease names of microbes and other environmental factors, and the body and, in particular, its constitution. The last they saw on the concept of the immutability of the hereditary substance. On the basis of this concept, recognized a fatal disease with vicious nom set of genes that disarmed the doctor because treatment of disease, according to supporters of this school, could not give a good results. On the basis of non-scientific views were made and reactionary political conclusions about the need to monitor the marriage, and in a very extreme and barbaric form applied fascism the destruction of millions of so-called "inferior" people, representatives of the "lower" yard. Representatives of this etiology as well as representatives of mono kausalism very considered the etiology of human disease and the cause of many diseases considered inferior genotype. The latest to me ¬ NIJ always sufficient to cause disease, and in addition, inherited from generation m generation inevitably leads to bo useful to have representatives of some sort of perverse set of carriers of genes.
Looks IV Davydov 1958.1962 require special analysis, as they do not fit completely into any of the above described ¬ toboggan areas of etiology, although contain some of the above ideas. The most complete of these views are presented in his latest book, "The problems of causality in pathology" 1962. I. Davidovsky believes that the selection of the causal factor of a large set of diverse conditions that affect the body in the process not only of ontogeny, but also. phylogeny is demon sages and can only lead to disappointment. The main provisions contained Davydov include: 1 negation special role in the causes of disease, 21 to reduce all phenomena in diseases only to the phenomena of adaptation, 3 denial of the qualitative features of pathological processes and disease in general, 4 exaggeration of the role of the organism in the development of the disease.
Role in the etiology of a disease
Among the supporters of causal thinking in medicine there is no consensus on the role of the etiologic factor. According to the ideas Virchow 1859,1886, etiological factor is the foundation and constant cause the disease in all its stages. Spread of the disease due to their successive defeats more areas of cells and tissues, and the two surfaces in contact and the transition of the pathological process from one to another. This view is metaphysical, as negated the development of pathological processes, is not considered part of the body and the pathogenetic factors in the development of the disease.
Speranski 1935 believed that the causative factor usually plays the role of a push, and then the disease process organized by the nervous system to the laws laid down in it as a result of the historical development of the species. So edged standard nerve degeneration occurs, from these positions even interpreted the development of infectious diseases. To a certain extent can be schematically divided into three main types of the etiological factors:
1. Some cases an etiological factor operates throughout the illness and plays a crucial role in its development and progression. Here, first and foremost, many acute poisoning, electric shock and death.
2. In the development of a number of diseases the etiological factor is just the impetus that triggers a process which then develops under the influence of pathogenic factors. Here, first and foremost, traumatic injuries and their consequences, burns, radiation sickness, some mental and physical illnesses caused by excessive action of the stimulus, disturbed function of the nervous system death of loved ones, factors causing intense fear, excessive joy, and other emotions.
3. Finally, for many diseases influence etiology persists throughout the illness. But its role in the various stages of the process varies. Depending on the body's resistance and due to the changing value etiological factor often observed phase of the disease.
Pathological response a brief, unusual reaction to a stimulus, often accompanied with long-term damage disability rights short-term increase or decrease in blood pressure under the influence of negative emotions.
Pathological process a painful change in the function and structure includes a variety of combination of elementary patological reactions without causing a drop in blood pressure disability rights lipoma, warts, atheroma, etc.
Pathological state is a persistent not reversible, it is very slow-growing disease process, a lifetime, or the outcome of the pathological process.
The terms "disease process" and "pathological" state "largely arbitrary and spend between Odd ¬ Kuyu bound is not always possible.
Causes etiology
Distinguish the causes of disease: external and internal.
External: Internal mechanical: shareware
physical heredity
chemical constitution
biological age
social sex
Conditions: There are conditions that predispose to disease or contribute to its development. All of these can be internal or external.

The external conditions that favor the development of disease related malnutrition, overwork, neurotic states, previously borne diseases etc.

The internal conditions that favor the development of disease are hereditary predisposition to the disease, pathological constitution, diathesis, etc. Terms and conditions:

1. Heterometria - the power of action.

2. Heterochrony - the duration.
3.Heterotopia - scene. Organotropic specific direction of the agent. Causal treatment

GENERAL PATHOGENESIS
Pathogenesis (ratos-disease, genesis-origin) - is the study of mechanisms of origin, course, and outcome of disease. He is closely associated with the etiology. Pathogenetic mechanisms in the physiological principle, so it would be better not to speak of the pathogenesis, and just about the genesis of the process. Some authors highlight two adjacent concepts: pathogenesis and pathokines. Pathogenesis - is the emergence of the process with its historical background. Patokinez - the development of an already existing process, with all its stages and forms, clinical and anatomic variations.
The most important and the most general law of the pathogenesis is, the principle of self development, self-propulsion and self regulation. This means that the process, once established, further develops the principle of "value" that is as a complex set of branched chain properties units sequentially includes work in certain morphological and functional systems education. On circle - (CIRCULIS VITIOUSUS) - causal interaction. The continuing development and integration of individual participants ¬ Cove pathogenesis determined by the laws of cause and effect, namely the development of the pathological process, injury to one authority, one structure is the reason for the injury of another body, another structure. These secondary lesions is cause damage to another body, the following structures and functions. Development of cause and effect relationships leading to a closure of range of primary and secondary injuries and disorders. These circles are called pathological vicious circle. Development of illness nor consists of the formation of many vicious circle. Disease is piling up cycle and to divide and spread out all vicious circles. Example: 1 with a heart defect, 2 with flatulence.


STRESS - from Eng. stress-strain.
The term was first introduced in the pathology of Canadian scientists Selye in 1963 and is widely used in connection with the increased interest in ¬ nym concept Selye, parsing many issues of modern pathology. In numerous experiments in various laboratory animals Selye found that a variety of effects caused by various pathological processes, intoxication, infection, trauma, burn, etc. Give rise to the body to a certain extent similar changes. Of these non-specific change and determine the state of an organism, which is referred to as stress. Stimuls that cause stress, were named stressors.
General adaptation syndrome.
Changes that occur in the body during times of stress, Selye described sindromom. General adaptation syndrome is named because its appearance is associated with a change in the overall condition of the body. Adaptation - because it helps overcome the harmful effects of NIJ ¬ extreme irritants and increases for a while non-specific resistance of the organism; syndrome ¬ IOM because the relationship observed in this phenomenon.
Morphological changes in the body are characterized by the general adaptation syndrome following triad: I relatively significant increase in adrenal cortex, 21 acute involution thymicolymphatic system, 3 appearance of bleeding ulcers in the stomach and duodenum. In this syndrome are distinguished: 1 alarm reaction, 2 stage of resistance and 3 stage history ¬ tion.
Alarm reaction (in Russian literature is sometimes referred to as the stage of mobilization, or emergency) consists of two phases: shock and antishock. Phase of shock is characterized by hypothermia, hypotension, CNS depression, a decrease in muscle tone, gemoconcentration, increasing the permeability of cell membranes (especially capillaries), the phenomenon of catabolism (malnutrition, emaciation) negative nitrogen balance, hypoglycemia, leukocytosis, passing in leukopenia, limfoieozinopeniey, hemorrhages, etc.
In antishock phase is characterized by various shifts in the opposite direction high blood pressure, giperhlorenemia, hyperglycemia, etc, which ultimately lead to the restoration of the imbalances and develop the next stage. Phase antishock accompanied by an increase of the adrenal cortex, increased mitotic activity and proliferation, particularly in pencil zone, and the growth hormone of the adrenal glands. If the animal does not die during the alarm reaction, the stage of resistance developing. This stage is different from the previous one in many ways. Adrenal cortex is enriched secretory granules ¬ Lamy exchange becomes anabolic dominated by synthetic processes or nonspecific resistance of the body, even to other stimuli increases the so-called cross-resistance. However, there are also times when the action is one of the pathogenic agent increases the sensitivity of the body to another the so-called cross-sensitization / eg increasing adaptation to cold lowers the body's resistance to drugs. With continued and John pathogenic stimulus intensity action adaptation abilities can be exhausted. This will cause a loss of resistance and the development of exhaustion, leading to various degenerative processes, and even the death of the body. Selye believed that stress is a result of a certain degree of wear of the biological system, so the state of stress can lead to early aging of the organism.
Traumatic shock. Shock a condition that occurs under the action of the body is excessive, unusual effects, accompanied initial excitation, which is replaced by a further depression of the central nervous system and exhaustion.
Selye Stress Syndrome
Under the action of ACTH produced cortisone and its derivatives steroids. Corticosteroids - are antiinsulin antiinflammatory.
1. Reduce the permeability of blood vessels, reducing the processes of extravasation and exudation.
2. Delay the development of connective tissue granulation shaft.
3. Delay infiltration and proliferation of cellular elements.
4. Inhibit the production of antibodies and phagocytosis.
5. Enhances the carbohydrate metabolism
6. Inhibit protein synthesis catabolism
7. On the water salt metabolism do not work.
8. Hipoplasis cause lymphoid apparatus causing lymphopenia, reduced eosinophil. Under the action of growth hormone allocated desocsicorticosteroid mineralocorticoids.
1. Enhances the development of connective tissue.
2. Violent reaction of phagocytosis.
3.Usilivayut protein synthesis anabolism
4. Carbohydrate metabolism do not work.
5. Pull Na and H20 powering selection of K +.
6. Increases the number of lymphocytes and eosinophils
To determine the status of the endocrine system is used in the clinic sample Thorne (preliminary count of eosinophils in 1 ml of blood - normally 150-300 pieces, then enter 10. ACTH. Repeatedly counted after 4 hours. Normally, a decrease of eosinophils by 50% - a positive result, the reduction of more than 50% negative response in case of an increase of more than 50% - of the reaction is considered rotation).
Traumatic shock occurs when damaged organs shock of the hip, the internal organs of the chest whereby the distinction.
a) plevropulmonalny shock when sbavlenii chest
b) visceral shock organs
in hemorrhagic shock blood loss
g) burn shock for large, extensive burns
d) shock at squeezing small tissues of the hip.
In the development of traumatic shock distinguish two stages or phases: the first, coming after the injury and is manifested activatsiey functions erectile, and the second, which is expressed in the oppression of torpid. was justified in the works of N.N. Burdenko 1951.
Erectile shock phase - the phase of the excitation outwardly manifested restlessness, crying, pallor of the skin and mucous membranes, an increase in arterial and venous pressure, tachycardia, and sometimes urinating defect.V this phase as a result of generalized arousal and stimulation of the endocrine apparatus activation of metabolic processes, while Tornier compass providing inadequate. This phase is a prerequisite for the development of inhibition in the nervous system, disorders of circulation and oxygen deficiency. Erectile phase transient and usually lasts a minute.
Torpid phase of shock - the phase of oppression, after developing erectile manifested physical inactivity, hyporeflexia, arterial hypotension and tachycardia, respiratory disorder or tachypnea bradypnea early or periodic breathing in oliguria, hypothermia, etc. In torpid phase of shock compounded metabolic disorders due to neurohumoral regulation and circulation tor software. These disorders vary in different organs. Torpid phase - the most common and produration phase of shock, its duration can range from several minutes to several hours.
Torpid phase of shock, in turn, is divided into:
a) terminal phase and
b) phase of irreversible changes.
For the terminal phase of shock is characterized by a relatively slow growth and, consequently, greater depletion of coping mechanisms are more significant and profound dysfunction of the organs. S.A.Seleznev distinguishes torpid phase of traumatic shock in initial period of stabilization period and the final period.
Pathogenesis:
The pathogenesis of traumatic shock has not yet been fully understood. There are significant:
1.spetsificheskie factors and injury
2 . nonspecific factors of injury.
The specifics depend on: a the location, the amount of damage and limit organ function. Nonspecific factors cause: 1 irritation of nerve receptors and conductor 2 loss of blood and plasma, 3 the appearance of biologically active substances.

Theory of the pathogenesis of traumatic shock is based mainly on the effect of non-specific factors. 1 Neurogenic. 2 toxemia biologically active substances are absorbed into the blood and cause all the phenomena occurring in the shock. 3 blood and plasma.

Burn disease
The problem of thermal burns recently acquired greater urgency. According to the WHO cause of death in the technically developed countries in recent years have taken first place in injury accidents. Of these burns is 5.2 -10%. In the U.S., the number of burn victims annually reaches 900,000. Pathology burns limited to local tissue changes it. Extensive and deep burn causes versatile, long lasting and severe functional disorders of internal organs and body systems, and so in recent years strengthened the concept of "burn disease". The term "burn disease" first used the Wilson 1938. This name emphasizes that the burn should be considered as a disease of the whole body, not just as a local thermal damaged skin. Create a picture of the periodization of burn disease. Most pathologists and clinicians discharge periods: burn shock, toxemia, infection, depletion and recovery.
Burn shock. Burn shock usually subdivided on erectile and torpid phase. For erectile period character HN - general excitement increased blood pressure, rapid breathing, increased gas exchange, increase in adrenalogical substances in the blood.
For torpid period is characterized by functional disorders such as cardiovascular failure, a decrease in blood volume, haemoconcentration, acute renal failure, oliguria, disruption of water and electrolyte metabolism, deep violation intermediate metabolism, liver damage, blockage of natural barriers of protection.
Theory of burn shock.
Neurogenic theory. In the last 20-30 years, and there was widespread recognition of the neurogenic theory and Ojo ¬ Doping shock. Most famous are investiga pathophysiologists IR Petrov, A. Gordienko and surgeons AV Cherry brandy
EXTREME CONDITION CAUSED

External factor

Introduction
Various environmental factors, or "extraordinary stimuli that constantly faced man can have pathogenic effects on the human body. These environmental factors may be mechanical, physical, chemical, biological, psychological. Pathogenic effects of such environmental factors occurs when the superiority of force of their impact on the body's ability to adapt, as well as in cases of a change in its reactivity. Moreover the degree of virulence of their relative and depends on the conditions associated external and internal environment of the body. The impact of all these effects on humans occurs in specific social conditions of existence, which have a large and often decisive significance in the occurrence of diseases.
It is important to identify the main conceptual idea disease and health, and adaptability of the human body. This is due to the fact that the disease is a new quality of a particular form of life of the organism. Disease, human interaction is a dialectical emergency stimulus, certain conditions and reactivity. Pathogenic environmental factors influence the overall reactivity and, above all, on its neurohumoral system, which determines the functional state of the activity and the degree of protective-adaptive and compensatory reactions. Depending on the cause of the disease, the reactivity of the organism and the environment in which there is a disease created by a combination of a variety of disorders, or a combination of functions and structure of cells, tissues, organs and regulate their systems.
In this paper, we consider the external pathogenic factors, such as (physical, mechanical and chemical) factors.
Virulence IMPACT

MOTOR FACTORS

Mechanical energy has on the body and damaging pathogenic action depending on the size and nature of the energy supplied physiological, physical, chemical and mechanical properties and the state of tissues and organs, subjected to the action of this energy.

Elasticity or elastic strain is called a property called material his property to be returned to its original state. The coefficient of elasticity (Young's modulus) haizes stiffness of the material, ie, its ability to resist deformation, and is given by E = v / E, where E - Young's modulus, the tensile stress, e - elongation.
a) Sprains and fractures. Elasticity and extensibility of tissues vary considerably in pathological processes. Thus, inflammation of tissue break easier when applying less tearing strength than healthy tissue. The bones of the old man who had lost elasticity due to calcification, broken by the action of a lesser tensile strength.
Sudden stretching may occur in combat and domestic trauma (separation of parts of the body, limbs, etc.) are destroyed when all tissue structures: skin, muscles, ligaments, bones, etc.
When a low impact and duration of restretching, and more pathogenic multiple effects that may result, for example, to a weakening of ligaments, joints and loosening habitual dislocation. When excessive filling content of hollow organs (stomach, bladder, intestines, etc.) as a result of the delay the evacuation of them can come smooth muscle atrophy, thinning of the walls of the body, atrophy of the glandular system and reduction of their secretory function. Aneurysm after a long stretch atrophy of the blood vessels and can cause them to break, accompanied by heavy bleeding.
b) Compression. Resistance of the tissues to compression varies. Have the greatest stability of the bone. So, for the deformation of the femur by compression required with a load of 685 kg cm. To crush the skull, requires 500 kg cm, since the skull bone plates have a peculiar connection and position in space, which increases the overall strength of the static pressure. However, if applied kinetic energy (load falling from a height of 1 - 1.5 m), to break the skull, rather load 0.5 kg/cm2.
The consequences of compression depends on the strength and duration of exposure, as well as the physiological state of a tissue or organ, and may include:
a) mild, when impaired circulation and nutrition of tissues are reversible and disappear after the elimination of squeezing factor;
b) moderate - small in force, but the long-term action sponding factors that after the blood circulation and nutrition of tissues lead to necrosis of tissue necrosis and pressure sores. From prolonged compression may occur atrophy organ or tissue (eg, atrophy of the healthy tissue around the growing tumor). When compression of the growing tissue, their growth slows or stops altogether (for example, the custom of "swaddling" stop the girls in Japan and China);
c) serious degree with a strong compression of essentially destroyed all amazed structure. Remain alive only those tissues that are not subjected to direct pressure.
c) Impact. Strike - effects on the body object moving with positive acceleration, or impact the air waves.
The damaging effect of a moving object on the body depends on the nature of the traumatic object, its speed and the magnitude of the kinetic energy, the area of ​​contact with the surface of his body and the state of the tissue.
The mechanism of the damaging effect of the kinetic energy of a moving body is reduced mainly to compression, and then the deformation of tissue structures traumatic body tears of soft tissue and blood vessels, bone fractures, etc. When you hit a blunt object and a relatively large area of ​​contact with the body of the subject is typical damage to internal organs with preservation intact integument concussion when struck on the head, viscera breaks when struck on the abdominal wall, etc.
In addition to local and distant organ injury and tissues, causing shock and the general reaction of the body, which in its most severe form occurs as a traumatic shock.
Blow air wave can occur at break bombs, shells, etc. mini air waves produced by explosions, characterized by sudden jump of pressure.
Destruction by air wave is the result of sharp contraction and thinning of concentric layers of air. Shock wave duration is approximately 0.001 second. Air shock wave can cause unilateral or bilateral rupture of the eardrum, bleeding in her defeat of the cochlea and vestibular apparatus. In addition, it can compress on abdominal wall and move the abdominal organs. By inhalation air wave causes rupture of alveoli and lung capillaries. In this case, damage to internal organs develop in the perfect no visible signs of damage to the skin and muscles.
Shock air waves are especially dangerous for the central nervous system. Skull and brain are physically liquid system enclosed in a hard shell. The brain, like water, is almost incompressible, but the blow may change its form without changing the volume (concussion).
Blow air wave on the skull can cause it to deform or break. Sometimes the bone structure of the skull are not deformed, but it gets a linear or rotational acceleration, which is transmitted to the brain. Linear acceleration brain moves as a whole without dividing it into parts. In the rotational acceleration, a shift of the brain within the skull and cause destruction (breaking) of the brain substance.