Pathophysiology

PATHOPHYSIOLOGY
GENERAL PATHOPHYSIOLOGY

Introduction to the subject
Pathological physiology studies the laws relating to the origin, development, and completion of pathological processes in the body. Without knowledge of the laws of "pathological processes” are very difficult to understand the diversity of clinical manifestations of the same process with its localization in various organs. Physiopathology studies the causes of common, typical disorders, establishes mechanisms for their origin and development, defines the nature of the biological processes and their outcomes.

Thus, the pathophysiology - the science of life of a patient man, the word "pathophysiology" comes from the Greek word patos-' suffering, sickness and logos- " teaching. "

By definition Alpern, pathological physiology - the science that studies the functional changes in a sick body and sets out general rules of origin, development, clinical course and outcome of disease processes. Pathological physiology considers pathological processes as qualitatively new (unlike physiological), the specific biological phenomenon, which are based on a simultaneous combination of this violation of physiological functions and this violation of compensatory and remedial.

Physiopathology divided into general and private (special) pathological physiology. Questions that make up the content of the general pathophysiology, the following:

1. General nosology - the study of disease as biological phenomena (disease as a reaction of the whole organism, the nature of the disease, stage of disease, disease outcome, the classification of diseases and pathological processes)

2. General etiology - the study of the causes and conditions of illness. Set to external environmental factors: ¬ chemical, biological, physical, psychological effects, social conditions as pathogenic factors in the occurrence of disease. Understand the issues of relations of causes and conditions in the event of a pathological process.

3. Common pathogenesis - the study of the mechanisms of disease processes. The most extensive section on pathophysiology.

4. The study of typical pathological process - inflammation, fever, peripheral circulatory disorders, metabolism, hypoxia, etc.

5. The study of the mechanisms of adaptation, compensation and rehabilitation of disturbed function.

6. Investigation of mechanisms to eliminate pathological processes by affecting these or other therapeutic measures (ex: perimental therapy).

7. The development of animal models of disease processes.

The concept of private Pathophysiology - embeds the general laws of learning, current illness and recovery ¬ formation function of various organs and systems of the body (heart, liver, nervous system, endocrine system, blood, ¬ of the circulatory, urinary, respiratory, and the study of the etiology and pathogenesis some pathological forms).

One of the important areas of modern molecular pathophysiology is pathophysiology. This science ¬ appeared relatively short time ago, it has more than 20 years of its existence, but it has turned into an independent science. Molecular physiology mainly studying the so-called molecular disease of animals and humans, which now has over 5000. It is the science of the future, as it gives the idea of ​​the intimate mechanisms of the disease, occurring at the level of cells and subcellular structures. Molecular Pathophysiology examines changes of cell organelles (mitochondria, ribosomes) in different diseases and produces molecular basis for rational therapy of diseases. In pathophysiological studies are a number of techniques. The main reception - pathophysiological experiment on animals. Experiment (from the Latin. "Experiment" - test, experience) - active impact on nature and the artificial reproduction of various natural phenomena with a view to understanding its objective laws. Stages of the experiment. In each experiment, the following stages:

1st Stage - building plans, objectives and goals. This is a very responsible and important step, which largely depends on the fate of the experiment. Experimental design should build on the existing knowledge and reflect the urgency of the problem.

Second stage - the process of active influence on the world, resulting in accumulated objective scientific facts. Getting the facts greatly contributes properly chosen experimental technique. As a general rule, the method of the experiment appears on the basis of the difficulties that must be addressed in order to achieve the goals set in the experiment. Procedure was developed for some experiments, it may be suitable for other experiments, acquire universal values ​. However, the application of the method must be reasonable, taking into account the useful information for the given conditions.

Third stage- analysis of the results and synthesis of new ideas (synthesis, building working hypotheses). Working hypothesis are powerful engines of science. The working hypothesis should not only organize the facts, but also provide the most ¬ better use of the result in the present and the future. Working hypotheses are always temporary and when new facts are replaced with new ones. Recently, with the development of computing devices that stage is increasingly done by machines, ie objectified. However, the value of human mental activity in this process is still extremely high.

Step 4 - is a practical test the correctness of the facts and representations. Practical activities are always setting new challenges further experiment. Thus, the experiment is a continuous, ongoing process of cognition ¬ of the world, who can not stop and freeze. Experiments in medicine and physiology are conducted in various forms. To date retains its value acute experiments (vivisection), although he lost the self-sufficient role that had in the past century. 'In the acute experiment using different methodological approaches: artificial isolation of organs and tissues, use section and artificial stimulation of various organs and tissues, sectioning at different abstraction levels of the CNS biopotentials from time ¬ private bodies and etc.

Acute time-limited, their occurrence in the study of the effects of disease causing agents. They violate the functions of the body and are often not able to reveal the mechanism of pathological processes. However, with the power to acute experiments physiopathology accumulated much material about the fleeting nature of many pathological processes, such as shock, hemorrhage, asphyxia, poisoning different.

Chronic experiment conducted long period of time at a single site. Possibility of numerous repeat study at one facility is an important advantage of the chronic experiment, before the sharp. Reproduced in its pathological processes closer to nature. Chronic experiment is a possibility of more long term monitoring and research of vital activity, better disclosure and interaction of systems at all stages of the disease. This ensures not only analytical but also a synthetic approach to the study of the pathogenesis of disease processes. It can be used techniques: the imposition of artificial fistula, removal of target organ in the skin flap, heterogeneous anastomoses nerve transplants of various organs, implantation of electrodes, etc. Clinical and functional tests in humans are also a form of chronic experiment.

A special form of chronic experiments are experiments to reproduce the pathological processes in animals (hypertension, hyperthyroidism, peptic ulcer disease, etc.).

Every year it gets a wider development of a new form of biological experiments artificial simulation, normal GOVERNMENTAL physiological and pathological functions. Created artificial models and automatic nerve centers, mechanisms of memory, use artificially prostheses, etc.

Thanks to the results of experimental studies, it was possible to resolve important issues of the pathophysiology, for example, the different sides of the etiology and pathogenesis of many disorders of nutrition and metabolism, inflammation, fever, infectious diseases, endocrine for and other violations. Of course, the model of the disease in animals can not reproduce all the phenomena characteristic for the same diseases for penitents in the wild. With them you can learn some very important preliminary information on the mechanism of the disease and the possibility of more effective therapies.

In pathophysiology, the following experimental methods:

1. Methods off (hysterectomy)

2. Methods of (transplantation and injection)

3. Methods vivisection (vivisection)

4. Explantation techniques (tissue culture)

5. Methods of stimulation.

6. The method of isolated organs (Claude Bernard)

7. Method angiostomy (London)

8. The method of parabiosis (Vvedensky - double life) to analyze the significance of humoral factors in the development of pathology

9. Tracer method

10. Fistula method (Pavlov)

11. The method of vascular perfusion fields carotid sinus (isolated organs).

12. Serological methods

13. Biochemical

14. Cybernetic method

15. Morphological methods.

16. Clinical observations on the patient body
Nosology
Nosology (from the Greek. "Nozos" - disease and "logy" - teaching) - the doctrine of the disease.Nosology is one of the most important parts of the theory of medicine: it includes teaching about the disease, classification and nomenclature ¬ round disease, the study of the diagnosis, etiology, pathogenesis, general principles of treatment and prevention of diseases. Some authors divide N, the total public and private, by analogy with the general and special pathology N. constantly evolving and becoming more complex, ahead of the level of development of medicine and related sciences and the dominant philosophical currents.

An essential element is the classification of diseases N, grouping them in related lines. The first scientific classification of diseases class was offered to Morgan. He identified two groups of diseases related to general signs - fever and surgical or external disease, and other symptoms of the illness in the nature of a little known, distributed localization.

Success of bacteriology and pathophysiological anatomy in the second half of the 19th century, raised high the etiologic role and morphological principles of classification. Along with the classification of diseases on organ localization was established by pathologic classification ¬ Skim units, whose number was growing with the development of science. With the new classifications marked a significant proprogress.

Draft international nomenclature and classification of diseases was first approved in 1960 in the international statistical conference in Paris, the Conference decided to revise them every 10 years due to changes in scientific views on the proprocession and pathogenesis of disease. At present, these revisions are made by WHO. Interna native nomenclature and classification of diseases and causes of death revised nine times, most recently in 1980. International Statistical Classification hundred diseases, injuries and causes of the "death / ICD / - one of the most important tools to ensure comparability of data on public health, epidemiology and health care facilities, both within the country and within the international scale. It facilitates automation a number of administrative and regulatory planning work. at present adopted the International Classification of Diseases 9th revision, according to which they are divided into 17 classes:

1. Infectious and parasitic diseases
2. Neoplasms.
3. Endocrine, nutritional, metabolic and immunity.
4. Diseases of the blood and blood-forming organs.
5. Mental disorders.
6. Diseases of the nervous system and sense organs.
7. Respiratory diseases.
8. Diseases of the digestive system.
9. Diseases of the genitourinary system.
10.Defect pregnancy, childbirth and the postpartum period.
11. Diseases of the skin and subcutaneous tissue
12. Diseases of the musculoskeletal system and connective tissue.
13. Congenital anomaly / birth defect /
14. Certain conditions originating in the perinatal period.
15. Symptoms, signs and ill defined conditions
16. Injury and poisoning.
Knowledge about the disease, to the beginning of the XX century.

Throughout the history of human society idea of ​​the essence of human disease, formed on the basis of their idealistic, or on the basis of the materialist philosophy.

In the era of ancient Greek culture Hippocrates V-IV century came to the conclusion that the human body is composed of hard parts bones, veins, vessel and liquid water blood, phlegm, black bile, yellow bile. Last, moving and mixing in the human body, mined all the vital signs and act on them. Hippocrates believed that the structure of the human body there is an unbreakable harmony, as expressed in the correct mixing water / Krasis / organism, which is typical for health, for violation of the right mixture Shivani moisture / dyscrasia / leads to disease. Nature, according to Hippocrates, tends to suppress the disease, bad offset by a moisture digesting them. So he called the doctor, first of all, to help nature.

At the same time there was another area of ​​medicine, whose members put the origin of the disease due to the changed of dense parts of the human body. This direction is called solidarity / solidas - tight /. It appeared on the basis of anatomical teaching of democracy, according to which all the bodies that make up nature, including man, is composed of tiny particles of atoms. The disease arises as a result of changes in the shape of atoms and their misuse of the provisions contained in the views of the disease, of course, are primitive. They could not disclose the nature of the disease and facilitate the development of effective treatment of sick people. But it is important to emphasize that the representatives of the development of diseases associated with intangible changes the human body and thus from the appeared from primitive animism, which, of course, for that era was progressive. But along with these world views in the same period there were vitalistic view, is recognized as the basic principle of life intangible factors, the "soul", "life and spirit", which determine the health status and cause of disease.

Idealistic conception of the disease have appeared under the influence of the philosophy of Plato and Aristotle 111.4 century BC . Galen II century AD created a new system of medicine. He took the most significant of Hippocrates and other prominent physicians. Carrier of life Galen believed pneumatic start in life, ingested with the air and shown as three and pneum: mental, located and the brain, the heart, the life, physical, and in the liver.

Recognizing four moisture Hippocrates, Galen major importance in causing disease attributed changes in the blood, in his opinion, are the four major elements: air, water, fire and earth. In contrast, the other three water, mucus, bile, black and yellow contain only one of the four main elements.

Galen believed that between body structure and function of a pre-established harmony, which is broken when it is useful. "These views on the disease survived for 15 centuries. Materialistic views on the disease at that time developed outstanding representative medicine east of Abu Ali Ibn Sina -Avitsena 980-103, which in contrast to speculative reasoning favored by experience and observation of effects on the body recognized environmental factors. Amazingly for the era of his suggestion that the cause of human disease are invisible creatures.

Developing beliefs about the origin of the Hippocratic disease due to improper bias juices, Avicenna attached great importance to human body type, and required an individual approach to each patient, as every human age, in his opinion, possesses its special nature.

The scientific development of medicine began in the era of the collapse of feudalism and the rudiments of capitalism Renaissance, XIV-XVII century. On the formation of ideas about the disease at that time begin to influence science first chemistry, for those physics, and later the anatomy and physiology. Then there are two trends in medicine: iatrochemical and iatrophisical, but about the essence of the disease are still naive. According to representatives Iatrochemical direction, disease due to changes in the chemical composition of the body juices, especially the digestive juices and blood. However, the quality of the main early life, she recognizes an intangible force, which regulates vital processes of the body.

The founder of this trend Paracelsus 1493-1541 developed the doctrine of the chemical elements of the human body, according to his ideas, they cause the manifestation of the disease. Development is determined by the special spirit of life "Archaea" staying in the same man gastric and protect it from the effects of harmful agents.

Representatives iatrophisical direction the mechanical view of the disease. They saw similarities between the tires and organs of the human body such as the heart, they were compared with the pump light with furs. Health and disease are explained on the basis of the laws of physics, and the emergence of diseases due to the limited movement of bodies.
In the middle of the XIX century, Virchow formulated his theory of cellular pathology / 1858 /. According to this theory, the disease arises arises due to changes in the cell under the influence of pathogenic factors, with the latter having a direct damaging effect on cells, Virchow required for studying the structure of disease using a microscope.

The theory of cellular pathology of Virchow has played a positive role in the development of medicine as explaining the occurrence of the disease and changes in the cell, requiring instead of fruitless discussion study of morphological changes that occur in humans during the Leznov, Virchow recognized the occurrence of material changes in disease in humans. He described the degeneration of cells and some tumors.

The human body is considered as the sum of Virchow cells, cell state. By ignoring the principle of integrity, naturally. He wrote of the diseased cells, the affected organ, and all disease processes considered local.

In the second half of the XIX century, a new, functional areas, has developed on the basis of the achievements of the normal physiological gies. In the development of this area played an important role Pashutin Focht.

Idealistic views on the disease in the capitalist countries in the XX century, and their critics. Psychosomatic direction in medicine extends as new theory in medicine. Psychosomatics common in capitalist countries, especially the United States. With the help of her even try to create a new science "of human relations" to justify the idea of ​​peaceful existence of different classes in the "welfare state" under capitalism. This direction is not one, it has a number of trends. Common to the different areas of psychosomatic medicine is the position that all diseases are psychosomatic. The main method of knowledge of the essence of disease is a subjective method of psychoanalysis. Philosophical basis Fredizma-subjective idealism. At the heart of the idealistic interpretation, in particular, mental illness, is dualistic representations on the structure and function of the mind and brain, the physiological and psychological. The basis of the disease is transformed into a "turn-conscious" unsatisfied instinct. Identification of such unsatisfied instincts psychosomatics pay exceedingly great attention, because the believe that the localization and specificity of the disease depends on the nature of mental injury death of a loved one, a failed love, etc. According Psychosomatics important figuratively, not drive the inevitable conflicts inside and resolve them;
The disease is characterized by:
1.Insufficient adaptive reactions of the organism
2.Losing disability.
3. environmental stimuli are the causes of disease. Period of the disease: a hidden or latent incubation
4. Prodromal
5. The period of full development of the disease
6. The outcome of the disease.
The outcome of the disease are as follows:
1. complete recovery;
2. recovery with residual incomplete recovery
3. persistent lesion bodies;
4. death.
Disease - a new, high-quality, functional and morphological violation life of the organism under the influence of stimuli through external and internal environment and occur when the relationship between the internal organs, between the internal organs and the central nervous system, between the internal organs and the environment, giving the pathological reactions characterized on lowered adaptability and disability.

GENERAL ETIOLOGY

Etiology - the reason, logos-doctrine is called the doctrine of the causes and conditions of the disease. Investigation of the causes of diseases and conditions necessary for the practice and the physician for optimal therapy and prevention of disease. The latter was properly assessed at the time of M. Ya Mudrova, who pointed out that protect healthy people from disease hereditary governmental or threatening, they prescribe appropriate lifestyle is easier than to treat them. Great importance to establish the causes of diseases, I.P. Pavlov said the following words: "A knowledge of the causes, of course, (essentially) the case of medicine. Firstly, knowing only the cause, you can accurately strive against it, and in the second, and more importantly to prevent its action, before the invasion of the body. Just knowing all the causes of disease, the real medicine becomes a medicine of the future, that is, in hygiene in the broadest sense. " Determining the causes of disease is often difficult, especially because the causes and conditions that cause the disease, begin action on the human body much earlier than the patient to see a doctor. Moreover, the cause of disease in a particular patient may be the factors that are adequate for most healthy individuals, therefore, to be understood under the etiology of a complex, unusual interaction of the human organism, pathogenic factors and the complex variety of conditions.

The idea of ​​a common etiology of disease to XX century. For many centuries, until the XX century, there were very superficial, one-sided understanding of the etiology of common diseases. The disease was associated with the introduction of organic "evil spirits" and other spiritual principles. The views of Democritus Hippocrates, Paracelsus . The achievements of science in the 11th and especially XVI - XIX centuries raised new challenges for medicine, which is lagging behind the overall progress of physics, chemistry, mathematics, biology was certain.
During this period, attempts were made to revise the previously dominant ideas about the etiology. Marked the end of the XIX century, opening of a number of microorganisms leprosy bacillus, the agent of relapsing fever, cholera, typhoid, malaria, tuberculosis, etc. pathogen. Advances in microbiology have influenced the development of etiology. Doctors at that time came to the conclusion ¬ NIJ that the vast majority of disease is caused by the introduction into the body of microbes. Even in cases where the microorganisms not detected, it is due to lack of research methods. Consequently, according to the ideas of the late XIX century, pathologists, rather than one causal factor impact on the human body to the disease originated. This trend in the etiology called monocausalism.
Representatives monocausalism recognizing pathogenic effects of microbes, do not consider the complex of specific permutation, ie conditions in which the interaction takes place with the pathogenic organism factors. They also ignored the role of organisms man possessed tremendous adaptive capacity, so even if the penetration of the pathogen into the human body, the disease often does not occur. For example, microsenses typhoid can penetrate into the body, but he is still healthy, have recovered from typhoid germs brow for a long time with held in the intestines and in the gallbladder. For this area was characterized by a mechanistic understanding of causality. Cause races in a simple relation to its effect on the body. Verified theory of practice. Pathology and bacteriology of the time soon became convinced that as a result of penetration of a microbe in the body, the disease does not occur. Monitor the progress of the disease in epidemics convinced that significant in causing disease and its course belongs to the body, as the severity of the same disease in different individuals varies.
General views on the etiology of disease in XX century. In contrast to the previous stage of development of medicine in the early XX century to create more favorable conditions for scientific break general theory about the causes of diseases and conditions, in fact, in Task XIX century already made three great discoveries in science: open cell, formulated the law of conservation and transformation of matter, and Charles Darwin developed the theory of evolution Thanks to the efforts of bacteriologists have opened pathogens tangible reason ¬ HN of diseases. Under capitalism, however in the study of the causes of disease appeared two idealistic new directions: 1. Conditionalism 2. Konstitualism may law view of the decisive role in the emergence of a flawed constitution, her illness.

Conditionalism.

Conditionalism conditio-condition is called the doctrine of the conditions that cause the disease. Conditionalism - for common cause, based on the positions of relativism that ignores the leading role of the causal factors and replacing the sum of its often random and quite equal in value terms. Supporters conditionalism seeing the crisis in the study of the causes of the disease caused by a mechanical approach to the solution of this complex issue monocausalism representatives of thinking in medicine went to the other extreme and generally deny the objective causality in disease occurrence, considering that in the study of pathological processes owls should find out the amount of conditions necessary for the phenomenon has taken place. In their view, there is no need to bind impact penetration, for example, with the introduction of communicable diseases into the human organism, which plays an ostensibly small major role than the other conditions of disease. In the analysis of the etiology of disease specific conditionality representatives of thinking often pick only the formal conditions, which played a role in their occurrence. Criticizing views monokausalism, Conditionalists - essentially proposes to abandon objective causality, replacing it with a subjective idealist pre representations. Collision conditionalism all shades of any phenomenon is the information to the external relations. Conditionalism as those in the general etiology based on a consideration of only a few arbitrarily chosen conditions of disease, instead of revealing the complex interaction of body and living conditions. The founder of conditionality method of thinking in medicine physiologist Feervon completely stood on the positions of the most reactionary bourgeois philosophy of subjective idealism. Just as Max tried to replace with rank mathematical concept of functional dependence of phenomena from each other, and Feorvon suggested replacing "kausalism" "air-nationalism" since conditionality approach, in his view, avoiding any "pulling out" of one factor and sets the dependence dependence phenomena from a set of conditions. According to Foervona every thing or event in reality is nothing more than a collection of its terms, and all the conditions of their own "just one content soul."
Conditionalism to this day is a very common teaching in a foreign medicine. In essence, once sighted analysis of the etiology of conditionality method is the so-called "constellation pathology." T., the representatives ¬ whether conditionalism deny determinism, subjectively assessed value of environmental factors in causing disease and ignored ¬ strated the role of the body.