Pathological physiology as a science. Methods of pathological physiology

Part I. General pathophysiology.

Subject, tasks and methods of pathophysiology. General nosology(Lecture No. I).

1. Pathophysiology as a science and academic discipline, its subject, tasks and research methods.

2. Characteristics of the pathophysiological experiment ͵ advantages and disadvantages of the experimental method.

3. Relationship of pathophysiology with other disciplines.

4. General nosology.

pathological physiology- this is a science, mainly in an experiment on animals, studying the general patterns of the occurrence, development and cessation of a disease and pathological processes in humans. This is the science of the vital activity of a sick organism or general pathology. The subject of the study of pathophysiology are general patterns, primarily of a functional nature at the level of the cell, organs, systems and the diseased organism as a whole, which determine the onset and course of the disease, the mechanisms of resistance, pre-illness, recovery and outcome of the disease. General patterns are derived on the basis of the study of pathological processes, conditions and pathogenesis of various syndromes and diseases.

Pathological physiology developed as an experimental science, however, along with this, clinical pathophysiology also developed, which, using harmless research methods, studied the issues of pathophysiology in the clinic. Τᴀᴋᴎᴍ ᴏϬᴩᴀᴈᴏᴍ, pathophysiology is a methodological science, it teaches the doctor the most general laws of the development of the disease and, on their basis, the solution of complex situations.

Every science must have its subject and its method. The subject of pathophysiology is a sick person, and the method is a pathophysiological experiment that makes it possible to reproduce models of human disease and pathological processes on animals and to study the problems of pathological physiology on these models.

Pathological physiology solves 6 tasks:

1) the study of problems of general pathology - the creation of a general doctrine of the disease or general nosology,

2) the study of the causes of the disease and the creation of a general doctrine of causality in pathology - that is, laws governing causes - this common etiology,

3) study of the general mechanisms of occurrence, development and termination of diseases and pathological processes - general pathogenesis- This the main task,

4) study typical pathological processes- the foundation of the disease (there are about 20 of them in various combinations),

5) study of the general patterns of disturbance and restoration of the activity of individual physiological systems and organs - private pathophysiology, where the most important is the study insufficiency system or organ

6) the rationale for new methods of treatment is the creation of a doctrine of the principles pathogenetic therapy- that is, the impact on the mechanisms of the development of the disease on the basis of knowledge of pathogenesis.

Research methods:

1. Pathophysiological experiment on animals;

2. Pathophysiological examination of a sick person (less typical).

The structure of the experiment and its features. The experiment can be acute or chronic.

Phases of the experiment:

1. Study of the initial background.

2. Obtaining a "model" of the disease and the study of its pathogenesis, mechanisms of the disease;

3. Pathogenetic therapy (regulation of mechanisms of pathogenesis).

Advantages experimental method of studying the disease before clinical:

a) in the experiment there is always the possibility of determining the initial level of indicators, the ability to quantify changes compared to the initial level with the background, but in the clinic the doctor does not have this,

b) thanks to the model obtained in the experiment, unlimited possibilities for studying the causes, since there is a strong connection between the acting causal factor and the developing pathology, since modeling is study of the cause,

c) in the experiment there is an opportunity to study the mechanisms of the initial, earliest phases of the development of the disease, hidden from clinical observation, and in fact they are the triggers,

d) in the experiment there are unlimited possibilities for studying pathogenesis - the deepest, most intimate mechanisms of pathology, because any methods can be applied,

e) experiment gives unlimited possibilities scientific justification development of new methods of treatment.

Various methods are used in the experiment: biophysical, physiological, biochemical, morphological, immunological.

Various types of acute experiment (vivisection) and chronic (method conditioned reflexes, implantation of electrodes into tissues, creation of fistulas).

Difficulties and disadvantages of the experimental method:

1) the choice of an animal for an experimental study,

2) all her diseases are modeled on animals,

3) it is difficult to transfer experimental data to the clinic,

4) it is difficult to create a model of the disease,

5) ethical issues.

Clinical pathophysiology has its own fundamental features, since various manifestations mediation Biological social processes are the most important link in the life of a healthy and sick person. The main apparatus of mediation is the nervous and other regulatory systems and labor activity, which, along with other factors, distinguishes a person from an animal.

Pathological physiology connects biological disciplines with clinical ones, as a bridge: the basis of pathophysiology as a science is biology, normal physiology, and biochemistry. Pathophysiology is associated with morphological disciplines (anatomy, histology, pathology), since. the study of function in isolation from the structure of the cell is impossible. Close connection with normal physiology does not mean identity. A variety of violations of the vital activity of cells, organs, the body as a whole in pathology still does not have " prototype"of these disorders in a healthy organism. Considering the dependence on the cause that caused the disease; on the reactivity of the organism and the influence external environment in the body itself, a variety of combinations of dysfunctions and reactive changes are created. In diseases, a number of changes are due to the forms of response of cellular elements, organs, physiological systems developed in the process of evolution and fixed by heredity in pathological conditions.

Pathophysiology as an academic discipline. In preparation practitioner pathophysiology equips him with knowledge of the general laws of the development of the disease, general principles disease management, equips the doctor with the correct methodology for the analysis of the disease and pathological processes. The teaching of pathophysiology aims to teach students to apply natural science at the bedside, ᴛ.ᴇ. to understand the mechanism of the development of diseases and the processes of recovery, based on the general laws of the activity of organs and systems. Τᴀᴋᴎᴍ ᴏϬᴩᴀᴈᴏᴍ, pathological physiology arms the physician the right way to reach the truth by the shortest route and simple methods, allowing you to quickly and economically analyze the pathology under study - ᴛ.ᴇ. is an methodology.

Benefits of pathophysiology- each disease consists of a small number of pathological processes - there are about 20 of them, which have common laws of development. For this reason, a thinking doctor can fully analyze any disease, and private details will no longer cause such difficulty (fever, inflammation everywhere develop according to the same laws, intertwine form various combinations.

General nosology- the general doctrine of the disease, essential elements which are:

a) damage,

b) reaction,

in) pathological process,

G) pathological condition ,

e) disease.

Reaction- the phenomenon of counteracting damage, aimed at eliminating it and restoring the original state. There is a certain correspondence between damage and reaction: with relatively weak damage, the level of reaction corresponds to or exceeds the damage. With severe damage, the level of reaction should be lower. The doctor judges the level of damage not by the damage itself, but by the reaction to it. In the case when the level of reaction is sufficient, this is good, but if the reaction is not enough to eliminate the damage, it is extremely important to increase it.

Types of reaction: 1) protective and adaptive performs adaptation to damage;

2) pathological, according to its mechanism, it is also protective and adaptive, but due to an unusual quantity or quality leads to secondary damage (fever, pus);

3) adaptive reactions - long-acting in the body in a changed environment of existence.

Pathological process- this is a combination of damage phenomena, protective-adaptive and pathological reactions. A typical pathological process is a regular combination of its constituent elements with their always the same strictly sequential inclusion (always in the same order, regardless of the location of the pathological process and its type). Characteristic features - dynamism and phase.

If the pathological process has stopped at some point in development, this is already pathological condition(process without movement).

The pathological process is closer in structure to the

disease, includes constituent parts, but the disease is more complex phenomenon.

General biological signs of health:

1) structural and functional usefulness of a healthy organism;

2) homeostasis - constancy of indicators internal environment, the ability to keep it and optimal level response;

3) the balance of the organism with the external environment, independence from it.

General biological signs of the disease:

1) the presence of a number of pathological processes with a violation of the structure and function of the organ;

2) violation of homeostasis, at least partially;

3) violation of the body's adaptation to changing environmental conditions with

decrease in biological and social activity.

When diagnosing a disease, it is extremely important to evaluate these 3 criteria of the disease and, in addition to biological indicators, indicators of adaptability to the external environment should be taken into account. This is easiest to do under load during functional tests, but this must be done carefully.

Disease(morbus) is a complex phenomenon, ĸᴏᴛᴏᴩᴏᴇ consists of a number of basic elements. There are always two sides to a disease: damage and reaction to it. The most important component disease element - homeostasis disorder and interaction of the organism with the external environment.

In case of illness, a number of homeostatic indicators change, which are held very tightly in the body and their shift leads to death (for example, pH). Although it should be noted that the bulk of the indicators can fluctuate to a certain extent (for example, body temperature, biochemical or cellular composition of the blood). Basically homeostasis - the maximum efficiency of the functioning of the body, the possibility of a more complete adaptation to changing environmental conditions. Homeostasis is useful in a healthy body, but in disease it is disturbed. Losing homeostasis, the body loses the usual mechanisms of regulation. Adaptation to the external environment will be inferior (for example, a child with a fever is very sensitive to hypoxia).

The term " disease" it is applied for:

1) disease designations specific person, the concept of the disease as a nosological unit and

2) a generalized concept of the disease as a biological and social phenomenon. The concept of illness is associated with a form of existence of an organism that is qualitatively different from health. But at the same time, these states are in close unity, since the states of health and disease represent, although different, but inextricably linked forms of manifestation of life.

General etiology. Damage(Lecture No. II).

1. The concept of etiology.

2. Damage, its types.

3. Indicators of damage to cellular structures.

General etiology- the general doctrine of causality in pathology. When considering the etiology of human diseases, difficulties arise in that many pathogenic factors can act on the body simultaneously or sequentially, each of which is capable of causing damage, and therefore it is very difficult to determine which of them is truly causal (UVI, cold, microbes , poor-quality food, emotional chronic overload).

Theories of etiology :

1. Monocausalism- single cause. For the occurrence of the disease, the action of one specific pathogenic factor is sufficient. This factor determines the picture of the disease, and the disease repeats its properties; it is, as it were, an imprint of the damaging effect of the factor. The merit of this theory is the discovery of the material substratum of the disease, its specific culprit.

2. As a counterbalance to monocausalism arose conditionalism According to which the disease occurs under the action of many equivalent factors, their combination should be considered the cause of the disease. Conditionalism does not single out a specific leading factor, but only a combination of equivalent factors.

3. As a variant of conditionalism - risk factor analysis disease, when each factor is given a quantitative expression in the origin of the disease. On analysis a large number cases one specific disease find out the relative frequency of factors in the origin of the disease.

4. Polyetiology- as an approach to the analysis of etiology. Specific forms diseases are caused by various specific factors (a tumor is caused by: radiation exposure, chemical carcinogens, biological agents).

5. Dialectical materialism implies that the disease occurs under the influence of many factors; among which the main causative factor and conditions are distinguished. Characteristic properties causative factors are:

1) extremely important,

2) it causes the emergence of a new phenomenon - a consequence,

3) it gives the disease specific features, and in more the specificity of the initial injury.

The cause of a particular disease is a dialectical process of interaction between the etiological factor and the body under certain conditions. The conditions themselves do not determine the specificity of the disease, but their action is essential for the emergence of a specific causal interaction. Allocate external conditions and internal, conducive and obstructive, sufficient and modifying.

Sufficient conditions- these are those without which the etiological factor will not cause pathology. These factors quantitatively determine the interaction of the causative factor with the body, facilitate or vice versa, counteract this interaction, but lack the main feature of the etiological factor - its specificity.

Τᴀᴋᴎᴍ ᴏϬᴩᴀᴈᴏᴍ, common etiology- the doctrine of the causes and conditions of the onset of the disease; in a narrower sense, the term "etiology" refers to the cause of a disease or pathological process. The cause of the disease is the interaction of the body with the etiological factor in specific conditions - as the initial trigger of the disease.

The main components of the disease are damage, reaction, pathological process.

Pathophysiology of damage(mechanisms of damage). Illness is the life of a damaged organism. At the root of any pathology lies damage and the reaction to this damage. Damage (alteratio - change) is usually called a violation of homeostasis caused by the action of an etiological factor in certain conditions. It should be violation of morphological homeostasis, that is, a violation of the anatomical integrity of tissues and organs, resulting in a violation of their function, violation of biochemical homeostasis - pathological deviations of the content in the body various substances in the form of excess or deficiency (hyperglycemia → diabetes → diabetic coma; hypoglycemia → hypoglycemic coma). Violation of the functional homeostasis is a pathological deviation of the functions of various organs and systems in the form raise or downgrades.

Types of damage, damage classification:

I) in time:

1. primary, caused by the direct action of the etiological factor: burns, acids, alkalis, electric current, microbes - determine the specifics of the damage,

2. secondary - as a result of excessive or perverted, not adequate response for primary damage.

II) specific and nonspecific.

III) by nature of the process: acute and chronic.

IV) by severity: reversible - necrobiosis and paranecrosis and irreversible - necrosis.

v) by outcome: complete or incomplete recovery and death.

Acute injury- the result of instantaneous changes in homeostasis under the influence of powerful damaging factors (acute developing cell ischemia): a) a sharp decrease in macroergs, b) a violation of lipid peroxidation, c) a decrease membrane potential and cell death.

Chronic damage- slowly developing cell ischemia is manifested by: 1) the accumulation of lipids as a result of a decrease in their peroxidation; 2) deposition of pigments (for example, cell aging pigment lipofuscin, which gradually accumulates and determines the life span of cells.

Acute cell swelling is reversible when signs of swelling disappear when ischemia ceases. Irreversible acute swelling is accompanied by a decrease in macroergs of purine bases and leads to cell death due to the inability to continue life. Death is accompanied by cell necrosis, irreversible changes in cellular structures as a result of autolysis of proteins, carbohydrates, lipids by lysosome enzymes - hydrolases. Death - cell death, can occur without necrosis under the action of fixatives such as formaldehyde, glutaraldehyde, which quickly destroy tissue enzymes and prevent necrosis.

Damage to cell membranes. The cell membrane is a layer of phospholipids into which protein molecules and lipoproteins are embedded. Protein molecules perform 3 functions:

1) enzymatic,

2) pumping or transport,

3) receptor.

The packing of these structures is carried out due to hydrophobic bonds. When these structures are damaged, first of all, protein molecules suffer, their ability to maintain the hydrophobic homeostasis of the cell is disturbed. Violated:

1) enzymatic activity,

2) permeability (the membrane of an intact cell does not pass colloidal dyes),

3) electrical conductivity and

All this leads to disruption of ion homeostasis, sodium ions accumulate in the cell, outside the cell K + , Ca 2+ , there is a threat of cell lysis, water release in case of tissue injury, swelling of brain tissues. During the day, 3-4 liters of fluid turns into lymph.

Pathophysiological indicators of damage to cells and subcellular structures:

1) total score- violation of the non-equilibrium state of the cell with its environment: the composition and energy of the cell do not correspond to the environment - higher energy, a different ionic composition, 10 times more water, 20-30 times more K +, 10 times more glucose than in the environment , but Na + in the cell is 10-20 times less.

2) the damaged cell loses its disequilibrium and is approaching environment, and a dead cell has exactly the same composition due to simple diffusion. Equilibrium organism with the external environment and is provided by this disequilibrium of the cell in relation to the environment. The loss of disequilibrium due to damage leads to the loss of K + , water, glucose, entropic potential by the cell, energy dissipation into the external environment (entropy - equalization of the energy potential).

Damage at the cell level must be specific. This specificity is determined by the etiological factor. For example, for mechanical damage, such a specific violation will be a violation of the integrity of the structure of tissue, cells, intercellular formations: compression, crushing, bruising, stretching, rupture, fracture, injury. For thermal damage, its specific expression will be coagulation and denaturation of protein-lipoid cell structures.

Nonspecific manifestations alterations:

1) acidosis,

2) increase osmotic pressure in a cage,

3) accumulation of water in a free state - vacuolization,

4) change in the colloidal composition of the protoplasm.

Dystrophic changes: protein degeneration, cloudy swelling, granular degeneration, fatty decomposition, infiltration, destruction of the nucleus: karyolysis - dissolution, karyorrhexis - decay, karyopyknosis - wrinkling. Necrobiosis, necrosis, damage to cellular structures, vacuolization of the cytoplasm, loss of organelle recognition, rupture of histoplasmic membranes develop.

transitional component from cellular level damage is damage to a functional element of an organ. The composition of the functional element of the body includes:

1. a parenchymal cell that provides the specifics of this organ: in the liver - a hepatocyte, in the nervous system - a neuron, in a muscle - a muscle fiber, in the glands - a glandular cell, in the kidneys - a nephron.

2. connective tissue components: fibroblasts and fibrocytes, hyaline and collagen fibers - a connective tissue skeleton that acts as a supporting apparatus.

3. nerve formations:

a) receptors - sensitive nerve endings the beginning of the afferent part of the reflex arc;

b) effector nerve endings that regulate various functions: muscle contraction, separation of saliva, tears, gastric juice;

4. microvasculature and

5. lymph capillaries.

microcirculation- this is blood circulation in the area: 1) arterioles, 2) precapillaries, 3) capillaries, 4) postcapillaries, 5) venules. The precapillaries end with a precapillary sphincter, during the contraction of which the blood, bypassing the capillaries, is discharged into the venules through arteriovenous shunts. There is a pathological deposition of blood, stasis in the capillaries, hypoxia.

This microcirculation system provides the functional element of the organ with oxygen and nutrients and removes carbon dioxide and metabolic products, provides movement biologically active substances and mediators(catecholamines, biogenic amines, hormones, kinins, prostaglandins, metabolites and parametabolites, ions, enzymes and other elements that determine the state of homeostasis.

General pathogenesis(Lecture No. III).

1. The concept of pathogenesis.

2. Elements of pathogenesis.

3. Role nervous mechanisms in the pathogenesis of diseases.

4. Features of the regulation of body functions in case of illness.

Pathogenesis is the study of the mechanisms of occurrence, development and termination of diseases and pathological processes.

The doctrine of pathogenesis based on general ideas about the disease, on the analysis of the role of the causative factor in pathology; the main link and cause-and-effect relationships; general and local changes in the reaction of the whole organism and is associated with the philosophical aspects of medicine. Often, the interaction of the etiological factor with the body occurs within a short period of time in the form of a trigger mechanism: the directed action of electric current, acids, high temperature for a fraction of a second. At the same time, the resulting pathological processes form a burn disease that lasts a long time, and the consequences of burns require various methods of treatment. Pathogenesis under the action of such extreme etiological factors is determined by internal pathogenetic factors that manifest themselves at the time of interaction of the etiological factor with tissues and organs, as well as as a result of their destruction and the formation of biologically active substances.

Pathological factors include:

1) irritation of receptors and nerve conductors,

2) release from damaged tissues of biologically active substances (histamine, serotonin, adenyl nucleotides, etc.),

3) the influence on the body of humoral factors of the response and not always adequate reaction of the neuroendocrine system (accumulation of mediators nervous excitement, glucocorticoids, catecholamines).

Elements of pathogenesis: distinguish the main (main) link of pathogenesis - ᴛ.ᴇ. trigger factor and pathogenic chain. The main link (triggering factor) of pathogenesis is such a phenomenon, ĸᴏᴛᴏᴩᴏᴇ determines the development of the process with its characteristic specific features under the influence of damage. It is from him that the pathogenetic chain is turned on, and without it the further development of pathogenesis is impossible.

Chain of pathogenesis- consistent inclusion of the leading mechanisms of the disease, interconnected by cause-and-effect relationships.

The leading factors of pathogenesis are included in time later than the main link. The pathogenesis includes the core mechanisms that ensure the specificity of this disease, and the doctor's task is to determine the pathogenesis of the disease among the variety of different manifestations.

To illustrate the chain of pathogenesis, let us analyze the development scheme of the pathogenesis of acute blood loss: the etiological factor (blood loss) causes a triggering factor, the main link (decrease in BCC) and reactions to a decrease in BCC: reflex vasoconstriction, an increase in the release of blood and fluid from the depot, an increase in the reaction of the respiratory system, and others . But if protective and adaptive reactions are not enough, then hypoxemia and tissue hypoxia develop, this leads to a pathological metabolic disorder, acidosis occurs → a violation of the activity of the central nervous system(especially the respiratory and vasomotor centers) → aggravation of hypoxemia → damage to cells and subcellular structures → accumulation of underoxidized products and further disruption of the functions of various body systems.

The most important mechanism for the development of the disease is a violation of the regulation of homeostasis and, especially, a violation of the mechanism of the functioning of feedback. This underlies the formation of vicious circles of pathogenesis, ᴛ.ᴇ. closure of the pathogenesis chain according to a circular type, when the resulting pathological deviation of the level of functioning of an organ or system begins to support and strengthen itself as a result of the appearance of a positive feedback. So, with blood loss, pathological deposition of blood, the exit of its liquid part from the vascular bed increase the deficit of the BCC, hypotension increases, which, in turn, activates the sympathoadrenal system through baroreceptors, enhances vasoconstriction, centralization of blood circulation, pathological deposition of blood and a further increase in CNS hypoxia, a drop in the excitability of DC and VMC. Timely diagnosis of the initial stages of the formation of a vicious circle and the prevention of its formation has great importance for the successful treatment of the disease. The outcome of the disease depends on the ratio of adaptive and compensatory mechanisms with pathological phenomena caused by the destructive effect of the etiological factor: inadequacy, inappropriateness of the body's responses: hyperreactions that exhaust the body occur or vicious circles of pathogenesis are closed, the elimination of which is possible only with complex treatment.

In many cases, the pathology is aggravated due to an overly active and inadequate reaction of the body, for example, with allergic reactions, pain shock. Too much irritation of the sensory nerves causes their certain local destruction, which is not life-threatening, and the body can die from pain shock.

Types of therapy:

1. Etiotropic therapy- the most effective type of therapy aimed at eliminating the etiological factor, but its possibilities are limited, since the effect of the etiological factor is usually short-lived.

2. Pathogenetic therapy- is aimed at the mechanisms of the pathogenesis of the disease, this is the leading method in modern conditions. Pathogenetic therapy is of great importance, its main task is to choose methods and means that can eliminate or weaken the action of the main link and leading factors of pathogenesis and enhance compensatory processes in the body.

3. Symptomatic therapy- is not aimed at pathogenesis, but only at eliminating the symptoms that bother the patient (for example, headache is present in many diseases and its elimination does not affect pathogenesis, this is only an external effect, something needs to be prescribed to the patient, to convince him of a speedy recovery.

Principles of pathogenetic therapy :

1. Pathogenetic therapy should be dynamic, changeable and correspond to the stage of the pathogenesis of the disease.

2. The most effective pathogenetic therapy is directed against the starting link of pathogenesis. If it is eliminated in time, then the disease stops. Pathogenetic therapy must be started very early, and its success depends on early diagnosis, before the chain of pathogenesis has branched out.

3. The intervention of a doctor must be mandatory and urgent in the following cases:

a) if possible, eliminate or reduce the damage,

b) under the influence of extreme factors (since protection is always insufficient),

c) with insufficient protective and adaptive mechanisms, even with relatively minor damage (for example, with immunodeficiency, microbial exposure leads to severe consequences),

d) when a vicious circle is formed - it must be immediately broken, otherwise there must be the death of the whole organism or its part, where the vicious circle formed.

4. The doctor should not interfere if it is impossible to influence the damage with a sufficient level of protective and adaptive reactions, because the body is capable of self-healing, self-healing. These are mechanisms of recovery prepared by nature, they are optimal. Nature heals, the doctor only helps healing. Attempts to increase responses when they are sufficient and appropriate to the injury become dangerous, as pathological reactions and secondary injury may occur. When exposed to protective reactions, the body loses fitness for the future (vaccinations removed the natural immune process and immunity began to be distorted, an allergy occurs). When the symptoms are suppressed, the disease is prolonged (when the fever is eliminated, the body's defenses are reduced).

Part I. General pathophysiology. - concept and types. Classification and features of the category "Part I. General pathophysiology." 2017, 2018.

Part I. General pathophysiology.

Subject, tasks and methods of pathophysiology. General nosology(Lecture No. I).

1. Pathophysiology as a science and academic discipline, its subject, tasks and research methods.

2. Characteristics of the pathophysiological experiment, advantages and disadvantages of the experimental method.

3. Relationship of pathophysiology with other disciplines.

4. General nosology.

Pathological physiology developed as an experimental science, however, along with this, clinical pathophysiology also developed, which, using harmless research methods, studied the issues of pathophysiology in the clinic. Thus, pathophysiology is a methodological science, it teaches the doctor the most general laws of the development of the disease and, on their basis, the solution of complex situations.

Pathological physiology solves 6 tasks:

1) the study of problems of general pathology - the creation of a general doctrine of the disease or general nosology,

2) the study of the causes of the disease and the creation of a general doctrine of causality in pathology - that is, laws governing causes - this common etiology,

e) the experiment provides unlimited opportunities for scientific substantiation of the development of new methods of treatment.

Various methods are used in the experiment: biophysical, physiological, biochemical, morphological, immunological.

Various types of acute experiment (vivisection) and chronic (method of conditioned reflexes, implantation of electrodes into tissues, creation of fistulas) are used.

Difficulties and disadvantages of the experimental method:

1) the choice of an animal for an experimental study,

2) all her illnesses are modeled on animals,

3) it is difficult to transfer experimental data to the clinic,

4) it is difficult to create a model of the disease,

5) ethical issues.

Pathological physiology connects biological disciplines with clinical ones, as a bridge: the basis of pathophysiology as a science is biology, normal physiology, and biochemistry. Pathophysiology is associated with morphological disciplines (anatomy, histology, pathology), since. the study of function in isolation from the structure of the cell is impossible. Close connection with normal physiology does not mean identity. A variety of violations of the vital activity of cells, organs, the body as a whole in pathology still does not have " prototype"of these disorders in a healthy organism. Depending on the cause that caused the disease; on the reactivity of the organism and the influence of the external environment, a variety of combinations of dysfunctions and reactive changes are created in the organism itself. In diseases, a number of changes are due to the forms of cellular response developed in the process of evolution and fixed by heredity elements, organs, physiological systems in pathological conditions.

Pathophysiology as an academic discipline. In preparing a practical doctor, pathophysiology equips him with knowledge of the general laws of the development of the disease, the general principles of disease management, equips the doctor with the correct methodology for analyzing the disease and pathological processes. The teaching of pathophysiology aims to teach students how to apply natural science at the bedside, i.e. to understand the mechanism of the development of diseases and the processes of recovery, based on the general laws of the activity of organs and systems. Thus, pathological physiology equips the doctor with the right method to achieve the truth in the shortest way and with simple methods that allow you to quickly and economically analyze the pathology under study - i.e. is an methodology.

Benefits of pathophysiology- each disease consists of a small number of pathological processes - there are about 20 of them, which have common laws of development. Therefore, a thinking doctor can fully analyze any disease, and private details will no longer cause such difficulty (fever, inflammation everywhere develop according to the same laws, intertwine, form various combinations.

General nosology- the general doctrine of the disease, the most important elements of which are:

a) damage,

b) reaction,

in) pathological process,

G) pathological condition,

e) disease.

Reaction- the phenomenon of counteracting damage, aimed at eliminating it and restoring the original state. There is a certain correspondence between damage and reaction: with relatively weak damage, the level of reaction corresponds to or exceeds the damage. With severe damage, the level of reaction may be lower. The doctor judges the level of damage not by the damage itself, but by the reaction to it. In the case when the reaction level is sufficient, this is good, but if the reaction is not enough to eliminate the damage, it is necessary to strengthen it.

Types of reaction: 1) protective and adaptive performs adaptation to damage;

2) pathological, according to its mechanism, it is also protective and adaptive, but due to an unusual quantity or quality leads to secondary damage (fever, pus);

3) adaptive reactions - long-acting in the body in a changed environment of existence.

Pathological process- this is a combination of damage phenomena, protective-adaptive and pathological reactions. A typical pathological process is a natural combination of its constituent elements with their always the same strictly sequential inclusion (always in the same order, regardless of the location of the pathological process and its type). Characteristic features - dynamism and phase.

If the pathological process has stopped at some point in development, this is already pathological condition(process without movement).

The pathological process is closer in structure to the

disease, includes components, but the disease is a more complex phenomenon.

General biological signs health:

1) structural and functional usefulness of a healthy organism;
2) homeostasis - the constancy of the indicators of the internal environment, the ability to maintain it and the optimal level of response;
3) the balance of the organism with the external environment, independence from it.

General biological signs disease:

1) the presence of a number of pathological processes with a violation of the structure and function of the organ;
2) violation of homeostasis, at least partially;
3) violation of the body's adaptation to changing environmental conditions with

decrease in biological and social activity.

When diagnosing a disease, it is necessary to evaluate these 3 criteria of the disease and, in addition to biological indicators, indicators of adaptability to the external environment should be taken into account. This is most easily done under load during functional tests, but this must be done carefully.

Disease(morbus) is a complex phenomenon that consists of a number of basic elements. There are always two sides to a disease: damage and reaction to it. The most important component disease element - homeostasis disorder and interaction of the organism with the external environment.

In case of illness, there is a change in a number of homeostatic indicators that are held very tightly in the body and their shift leads to death (for example, pH). Although it should be noted that the bulk of the indicators can fluctuate to a certain extent (for example, body temperature, biochemical or cellular composition of the blood). Basically homeostasis - the maximum efficiency of the functioning of the body, the possibility of a more complete adaptation to changing environmental conditions. Homeostasis is useful in a healthy body, but in disease it is disturbed. Losing homeostasis, the body loses the usual mechanisms of regulation. Adaptation to the external environment will be inferior (for example, a child with a fever is very sensitive to hypoxia).

The term " disease" it is applied for:

1) the designation of the disease of a particular person, the concept of the disease as a nosological unit and

General etiology. Damage(Lecture No. II).

1. The concept of etiology.

2. Damage, its types.

3. Indicators of damage to cellular structures.

General etiology- the general doctrine of causality in pathology. When considering the etiology of human diseases, difficulties arise in that many pathogenic factors can act on the body simultaneously or sequentially, each of which can cause damage, and therefore it is very difficult to determine which of them is truly causal (UVI, cold, microbes, poor-quality food , emotional chronic overload).

Theories of etiology :

3. As a variant of conditionalism - risk factor analysis disease, when each factor is given a quantitative expression in the origin of the disease. Based on a large number of cases one specific disease find out the relative frequency of factors in the origin of the disease.

4. Polyetiology- as an approach to the analysis of etiology. Specific forms of the disease can be caused by various specific factors (the tumor is caused by: radiation exposure, chemical carcinogens, biological agents).

5. Dialectical materialism implies that the disease occurs under the influence of many factors; among which the main causative factor and conditions are distinguished. The characteristic properties of the causative factor are:

1) necessity,

2) it causes the emergence of a new phenomenon - a consequence,

3) it gives the disease specific features, and to a greater extent the specificity of the initial damage.

The cause of a particular disease is a dialectical process of the interaction of the etiological factor with the body under certain conditions. The conditions themselves do not determine the specificity of the disease, but their action is necessary for the occurrence of a specific causal interaction. Allocate external conditions and internal, conducive and obstructive, sufficient and modifying.

Sufficient conditions are those without which the etiological factor will not cause pathology. These factors quantitatively determine the interaction of the causative factor with the body, facilitate or vice versa, counteract this interaction, but lack the main feature of the etiological factor - its specificity.

Thus, common etiology- the doctrine of the causes and conditions of the onset of the disease; in a narrower sense, the term "etiology" refers to the cause of a disease or pathological process. The cause of the disease is the interaction of the body with the etiological factor in specific conditions - as the initial trigger of the disease.

The main components of the disease are damage, reaction, pathological process.

Pathophysiology of damage(mechanisms of damage). Illness is the life of a damaged organism. At the heart of any pathology is damage and a reaction to this damage. Damage (alteratio - change) is a violation of homeostasis caused by the action of an etiological factor under certain conditions. It could be violation of morphological homeostasis, that is, a violation of the anatomical integrity of tissues and organs, resulting in a violation of their function, violation of biochemical homeostasis - pathological deviations in the content of various substances in the body in the form of excess or deficiency (hyperglycemia → diabetes → diabetic coma; hypoglycemia → hypoglycemic coma). Violation of the functional homeostasis is a pathological deviation of the functions of various organs and systems in the form raise or downgrades.

Types of damage, damage classification:

I) in time:

1. primary, caused by the direct action of the etiological factor: burns, acids, alkalis, electric current, microbes - determine the specifics of the damage,

2. secondary - as a result of an excessive or perverted, inadequate reaction to primary damage.

II) specific and nonspecific.

III) by nature of the process: acute and chronic.

IV) by severity: reversible - necrobiosis and paranecrosis and irreversible - necrosis.

v) by outcome: complete or incomplete recovery and death.

Chronic damage- slowly developing cell ischemia is manifested by: 1) the accumulation of lipids as a result of a decrease in their peroxidation; 2) the deposition of pigments (for example, the pigment of cell aging lipofuscin, which gradually accumulates and determines the life span of cells.

The term " pathophysiology"comes from two words:" pathology" and " physiology». « Pathology"translated from Greek means the doctrine of the disease (pathos - illness, suffering; logos - teaching)," physiology"-the doctrine of the nature of the organism (physis - nature; logos - doctrine). Thus, "pathophysiology" is the science of the vital activity of a diseased organism.

Pathophysiology is a science that studies the general patterns of the occurrence, development and outcome of diseases and pathological processes.

A number of important concepts of pathophysiology, such as stress, predisease, reactivity, resistance, constitution, diathesis, refer to healthy individuals.

The constitution of the World Health Organization (WHO) defines pathophysiology as " basis of medical professional intelligence".

Pathophysiology as a fundamental science and academic discipline studies the general patterns that determine the occurrence, course and outcome of the disease, reveals scientific foundations etiology, pathogenesis and sanogenesis. The variety of arising violations of the vital activity of cells, organs and systems depends on the strength and quality of the emergency stimulus, conditions and reactivity of the organism. Founder of Russian pathophysiology as independent discipline V.V. Pashutin believed that pathophysiology is the philosophy of medicine. It plays a leading role in the fight against unscientific concepts in general pathology.

methodological the basis of the subject is the method of dialectical materialism. From a dialectical-materialist position, pathophysiology reveals the scientific foundations of the origin of the disease, diagnosis and recovery (construction of the theory of medicine), develops models of pathological phenomena, principles (symptomatic, etiological, pathogenetic, sanogenetic) of experimental therapy.

Methodological principles pathophysiology are the principle of biosocial determinism, the principles of unity of analysis and synthesis, organism and environment, structure, function and metabolism, theory and practice, the principle of comparative pathology.

The subject of study of pathophysiology is the vital activity of a diseased organism at the molecular, cellular, organ, and system levels.

The subject of pathophysiology is the totality of knowledge accumulated in the study of:

Essences of diseases;

Causes and conditions for the occurrence of diseases;

Mechanisms for the development of diseases;

Typical pathological processes;

Patterns of damage to individual organs and systems.

Pathophysiology- integrative science. Occupying special place in the system of higher medical education, it has broad theoretical and methodological connections with other disciplines.

First of all, pathophysiology relies on the sciences that study the properties of environmental factors that can cause the occurrence of diseases, as well as influence the course and outcome. These include physics, chemistry, biology, microbiology, sociology. These disciplines form the theoretical basis necessary for the study etiology.

In addition, to study pathophysiology, it is necessary to have a fairly wide range of knowledge about the structure, function and metabolism of the body in conditions of the norm. This goal is served by such disciplines as anatomy, histology, normal physiology, biochemistry, and genetics.

And, finally, the main place in the system of higher medical education is occupied by clinical disciplines, in relation to which pathological physiology plays the role of theoretical basis because it is the cornerstone of the doctor's scientific medical worldview.

The purpose of pathophysiology as an academic discipline is to form the theoretical foundations for understanding the etiology, pathogenesis, clinical manifestations, principles of disease prevention and treatment; obtaining fundamental information about the essence of the disease and the laws of its development; formation and development, ultimately, of clinical thinking.

The pathophysiological approach to solving the problems of clinical medicine is increasingly being introduced into the most various areas practical medicine. In all areas of modern medicine, the latest methods of laboratory and instrumental diagnostics are used, the analysis of which gives an idea of the pathogenesis of dysfunctions of cells, organs, and systems of patients. During the treatment, special medicines perform therapeutic procedures. Based on the pathophysiological theory, the principles and methods of etiological and pathogenetic prevention are formed. Pathophysiological criteria underlie the definitions and classifications of diseases. None of the above can be done without knowledge of pathophysiology.

Pathophysiology consists of 2 sections:

1.General pathology.

It includes:

a/ general nosology - the doctrine of the essence of the disease.

General nosology

Forms the basic concepts and categories of pathology;

Develops the principles of classification and nomenclature of diseases;

He studies the social aspects of pathology.

b/ common etiology – study of the causes and conditions of disease.

General etiology studies:

General properties pathogenic factors;

The significance of conditions in the occurrence of diseases;

Principles of etiotropic prophylaxis and therapy.

in / general pathogenesis – the doctrine of the mechanisms of the development of the disease. The doctrine of pathogenesis includes:

Mechanisms of body resistance to the action of pathogenic factors;

General mechanisms of disease development;

mechanisms of recovery;

Dying mechanisms;

Principles of pathogenetic prophylaxis and pathogenetic therapy.

G/ the doctrine of heredity, constitution and reactivity;

e/ the doctrine of typical pathological processes.

2. Private pathophysiology.

Considers violations in individual organs and systems, as well as the etiology and pathogenesis of the most common nosological forms.

Tasks of pathophysiology

The tasks of medical science are to ensure the advanced development of fundamental research and increase the efficiency of applied work. In this regard, pathophysiology is called upon to solve the following tasks:

1. Establishing the essence of the disease.

2. The study of the causes and conditions for the occurrence of diseases.

3. Disclosure of the mechanisms of the development of the disease and its individual manifestations, the mechanisms of recovery and dying.

4. The study of the basic laws of the functioning of the body in conditions of pathology.

5. Creation of experimental models of pathological processes.

6. Systematization and analytical and synthetic processing of clinical experimental material.

7. Development and implementation of effective methods of early diagnosis, preventive measures, principles of etiopathogenetic therapy.

8. Further development clinical pathophysiology.

Pathophysiology as an academic discipline forms theoretical basis for a deep understanding of the etiology, pathogenesis, clinical manifestations, principles of treatment and prevention of diseases. This goal defines a special place for pathophysiology in the system of training a doctor of any specialization and requires comprehensive integration with the biological sciences (biology, biochemistry, anatomy, histology, physiology, etc.), which form the foundation of pathophysiology, and clinical disciplines (therapy, surgery, pediatrics, etc.). .), in relation to which pathophysiology acts as a theoretical basis.

AT last years rapidly developing clinical pathophysiology based on the wide use of modern highly informative biophysical, biochemical, electrophysiological and other research methods directly in the clinic. This makes it possible to carry out harmless targeted studies on patients and use the knowledge gained about pathological processes occurring in the body, about the nature of compensatory-adaptive mechanisms, about methods of laboratory and functional diagnostics to select a rational differentiated method of treatment.

At present, it is possible to distinguish the following tasks of clinical pathophysiology:

1. The study of general and particular patterns of development of diseases in a sick person. Establishing their connection with the reactivity of the body, as well as the influence on their implementation of the personality of the doctor and the content of therapy.

2. The study of the pathogenesis of a particular disease in a particular patient in order to increase the effectiveness of therapy.

3. Formation of pathogenetic principles of therapy, adequate state of the art concepts of pathogenesis.

Methods of pathophysiology

In pathological physiology, two main methods are used:

Method of clinical observation. It consists directly in monitoring the course of a person's disease with the help of practically harmless targeted functional diagnostic methods (biochemical, immunological, electrophysiological, etc.). The advantage of this method is that there is no need to create an experimental model. The researcher observes a specific disease or pathological process at the bedside of the patient. However, this method does not make it possible to study the processes occurring in the human body in the latent and prodromal stages. In addition, the researcher is limited in assessing the causes and conditions for the development of the disease. Despite this, clinical pathophysiology is in a certain aspect the pinnacle of comparative pathology, for it is human pathology. The main task of clinical pathophysiology is to study the most general issues etiology and pathogenesis of human diseases.

Experiment is the main method of pathophysiology. Experiment is the modeling of diseases and pathological processes on living objects. Animals can serve as such objects. various kinds, individual organs, tissue cultures, individual cells, and even subcellular structures. .

The experiment includes modeling of pathological phenomena at various levels of organization of the body (molecular, cellular, tissue, organ, system, organism), expands the possibilities of understanding the essence of the pathological process, contributes to the formation of clinical thinking in the doctor, the ability to use clinical knowledge in solving issues of diagnosis, treatment and prevention various diseases.

To study impaired functions, various research methods are used:

Experimental-pathophysiological (electrophysiological, biophysical, pathochemical, immunological),

Clinical and pathophysiological (laboratory, functional test method),

Statistical, etc.

Experiments are divided into acute and chronic. The choice is made depending on the purpose of the study. For example, an acute experiment is used to study the mechanisms of the occurrence of shock states, while an experiment with inoculation of a tumor in an animal should be of a chronic nature.

In addition, all experiments in pathophysiology can be conditionally divided into synthetic and analytical. When modeling a disease or syndrome, the researcher solves a synthetic problem. Synthetic experiments are usually carried out in vivo. In an analytical experiment, from a disease, as a holistic phenomenon, some component, a mechanism, is singled out, which is most often reproduced. in vitro.

The pathophysiological experiment consists of the following steps:

1. Formation of a working hypothesis - determines the purpose and objectives of the study.

2. Choice of a model and method corresponding to the tasks set, ensuring appropriate control.

3. The planning of the experiment should ensure the correct conduct of the experiment, the exclusion of extraneous and additional influences on the model.

4. Analysis of the obtained results and formulation of conclusions. After the end of the experiment, all digital material is subjected to statistical processing to determine the average values, their deviations, reliability. Conclusions are formulated.

The following basic experimental techniques are used to study pathological processes.

Shutdown method consists in the removal of any organ by surgery or turning off its function by various influences (high or low temperatures, ionizing radiation, pharmacological preparations, specific antibodies). This technique is used to model diseases of the endocrine and nervous systems, to study the compensatory and plastic capabilities of paired organs.

Turn on method may consist in the introduction into the body of any substances (hormones, antigens, antibodies, enzymes) to simulate endocrinological, immunological diseases. In addition, experiments with organ transplants belong to this group.

Irritation method used to change the functional activity of an organ.

Method of isolated organs provides information about the essence of pathological processes in each specific organ or tissue.

Parabiosis method building in two animals unified system blood circulation to study the humoral mechanisms of various effects.

Tissue culture method is used to obtain information about the essence of pathophysiological processes, both in the whole organism and in an isolated organ.

Comparative evolutionary method studies, as a rule, typical pathological processes in the evolutionary aspect. The pathological process, as we observe it in humans and animals, is the result of the formation relevant reactions in the evolution of the animal world. Such pathological processes as inflammation, fever, arose and became more complicated in evolution due to the complication and improvement of the protective and adaptive reactions of organisms to changing living conditions. That's why the right scientific analysis human reactions to pathogenic effects requires a more complete knowledge of the ways and forms of their formation. This is possible only when using the historical method of comparative pathology.

The implementation of the experiment is associated with many difficulties, which are due to the complexity of pathological processes, the irreproducibility of a number of pathological processes observed in humans, etc.

In animal experiments, it is impossible to create a complete model of human disease. The human body is much more complex than the most highly organized animals and is exposed to social factors. In this regard, there is a need for clinical pathophysiology, which is designed to significantly complement experimental studies clinical, carried out directly on patients.

Nevertheless, thanks to the pathophysiological experiment, material has been accumulated that constitutes the content of pathological physiology. Human diseases are too complex, and their mechanisms are hidden too deeply. It is difficult and even impossible to open them, despite the use of the most modern technical means. The simplicity of animal testing is a positive thing at a certain stage of scientific analysis. Not in an experiment on a person, a rabbit, not even a frog, but on a transparent starfish larva I.I. Mechnikov observed the process of phagocytosis.

"Pathophysiology arose as experimental science in connection with the need for an accurate, natural-scientific study of the mechanisms of the emergence, development and elimination of pathological processes» ( Kryzhanovskiy G.N., 1997 ). Currently, it is one of the fundamental, integrating disciplines in the higher medical school. Pathophysiology is the theoretical basis of the doctor's training system, the formation of the foundations of his clinical thinking. The term "pathological physiology" was first used in the 17th century by J. Varandes, according to other sources - Galiot, who in 1819 published a textbook called "General Pathology and Pathological Physiology" founder Russian pathological physiology as a science and academic discipline is Viktor Vasilievich Pashutin . He created at Kazan University the first in Russia Department of Pathological Physiology in 1874 . In modern literature, both in scientific and educational , instead of phrases "pathological physiology" " accepted apply term "pathophysiology ". (from the Greek pathos - suffering; physis - nature, essence; logos - teaching, science). This term is a priority in Russia and in the countries of Eastern Europe. In the West, in particular in French-speaking countries, "physiopathology" is more often used, and in English-speaking countries - "general pathology" What is pathophysiology, what kind of science is it, what does it study? Despite some discrepancy in terminology, the issues that are considered by this science, regardless of the nationality of scientists, are the same. . And so, pathophysiology is a science that studies the most general patterns of occurrence, development and outcomes of pathological processes, typical pathological processes and diseases. Literally translated, it is the science of the vital activity of a sick organism. But it by no means follows from this that a healthy organism is out of sight of pathophysiologists. Important pathophysiological concepts such as resistance , constitution, stress, diathesis and a number of others refer to a healthy organism. N.N. Anichkov once even said: “... that normal mechanisms can only be known when they become dependence on abnormal reactions". Under the influence of various pathogenic factors, using its adaptive mechanisms to the maximum, a healthy organism reveals its own, genetically determined capabilities more fully, functions outside the relatively narrow ranges inherent in a calm existence. The definition of the concept of "pathophysiology" can be approached from the other side. Each organism has a unique life program that has developed in the process of evolution and is encoded in the genetic apparatus. According to this program, the origin, development and manifestation of various forms of the body's activity take place. Consequently, the entire activity of the organism, the optimal characteristics of its functioning are genetically determined. A.M. Ugolev defined physiology as a science of technology living systems , meaning by this a method of solving a particular problem by various systems of the body. Thus, the technological task of the external respiration system is the optimal oxygenation of erythrocytes with a minimum expenditure of energy resources, the urinary system is the removal of various metabolic products and the preservation of substances useful for the body, etc. Based on this, one can define pathophysiology as a science of technological errors and technological defects in the functioning of living systems, a kind of biological defectology"(Zaichik A.Sh., Churilov L.P., 1999). 1.2. Subject, purpose and tasks of pathophysiology. Science, unlike "non-science", according to J. J. Thomson, must have a subject and a method of research. The subject (object) of the study of pathophysiology is, regrettably, a human disease. From here - The main goal of pathophysiology is to establish the most general patterns, the laws according to which the pathological process, the disease develops. In accordance with the purpose the tasks of our science are:

study of the general patterns of specific mechanisms (underlying the body's resistance) of the emergence, development and completion of pathological processes and diseases;

the study of typical pathological processes (stereotypical combinations of phenomena), the various combinations of which determine clinical picture human diseases;

study of typical forms of violation and restoration of the functions of individual organs and systems of the body;

the study of transitional states between health and illness (pre-illness);

systematization and analytical and synthetic processing of factual material;

creation of new methods for modeling pathological processes and diseases;

On the basis of theoretical and applied knowledge, to contribute to the formation of the doctor's thinking, i.e. not only to transfer modern knowledge to the student, but also to teach him how to use this knowledge in order to be able to build in logical system chain of phenomena under study.

1.3. Structure (content) of pathophysiology.

Pathophysiology, as a science and academic discipline, consists of three main sections with several subsections: I. General nosology (nosos-disease + logos-teaching) 1 . General Doctrine of Disease: a) basic concepts and categories of pathology; b) classification and nomenclature of diseases; c) social aspects of pathology. 2 .General etiology(aithia-cause): a) general properties of pathogenic factors; b) the main categories of pathogenic factors; c) the significance of conditions in the occurrence of diseases; d) principles of etiotropic prophylaxis and therapy. 3 .General pathogenesis(pathos + genesis - origin): a) mechanisms of resistance of the organism to the action of pathogenic factors; b) general mechanisms of disease development; c) recovery mechanisms; d) dying mechanisms; e) principles of pathogenetic prophylaxis and therapy. 4. The doctrine of reactivity, resistance and the constitution of the body II. The doctrine of typical pathological processes: cell pathology, peripheral circulation and microcirculation, hypoxia, inflammation, tumor growth, allergies, metabolic disorders, etc. i.e. those processes that often occur in various combinations in many diseases III. The doctrine of standard forms pathologies of organs and systems of the body: blood, circulation, respiration, digestion, excretory, endocrine and nervous systems, as well as the liver. Sections I and II are combined under the title "general pathophysiology", chapter III is denoted as "private pathophysiology". Of all sections of pathophysiology, private pathophysiology is closest to clinical disciplines, but:

the clinician studies the disease in a particular patient, with all the features of its occurrence, development and outcome;

pathophysiologists study those general patterns of development of pathological processes and diseases that occur in various organs and systems of the body - cardiovascular, respiratory, digestive, etc.

Recently, thanks to the improvement of non-invasive methods for studying sick people (biophysical, biochemical, electrophysiological, etc.), pathophysiologists have been able to observe the pathological process in dynamics in vivo, and this has made it possible to develop clinical pathophysiology. The tasks of clinical pathophysiology are as follows:

study and analysis of the nature and severity of violations of body functions at each stage of the disease;

identification of the relationship between pathogenesis and its clinical manifestations (symptoms);

identification of the degree of influence of the pathological process on the affected organ or tissue, as well as on other organs and systems of the patient's body;

the ability to use the methods of functional laboratory diagnostics to assess the degree of dysfunction of organs and systems and the choice of pathogenetically substantiated treatment;

evaluate the specific and nonspecific reactivity of the patient, take into account its features when choosing the optimal methods of treatment for a particular patient;

Clinical pathophysiology can rightly be considered one of the main sections pathophysiology.

1.4. Relationship of pathophysiology with other medical disciplines.

Pathophysiology, being at the intersection of theoretical and clinical disciplines, is an integrative biomedical science. First of all, it relies on those sciences that precede it - anatomy, biology, chemistry, physics, histology, biochemistry, physiology, etc. Pathophysiology has a lot in common with physiology. Both disciplines seek to discover the laws by which the body lives and functions, which is of great importance in understanding the essence of the disease. Sometimes our science is even called clinical physiology. However, it would erroneously believe that the disease is just another combination of normal physiological processes. Pathological process leads to qualitatively new state of the body. Hence the difference between pathophysiology and physiology - the study of all the various forms of the disease, in order to reveal the laws by which it develops. It is especially necessary to dwell on the relationship of pathophysiology with pathological anatomy. These two disciplines are closely related, moreover, until 1874 it was one science. Separation due to the fact that only the basis of morphological analysis is impossible understand the dynamics of the pathological process, dynamics functional disorders. Yes, functional changes are interconnected with structural disorders, but there is not always a strict correspondence, identity between them. Why is this happening? The fact is that each organ, system, and the organism as a whole have compensatory-adaptive mechanisms. In this regard, when the structure changes, a change in function is not always noted. That is why a number of clinical issues could not be resolved during the autopsy of the corpse with subsequent microscopic examination of the sectional material. In order to overcome this, A.I. Polunin in 1869 singled out a general experimental section from the course of pathological anatomy, which began to exist independently in the form of the Department of General Pathology of Moscow University. At the same time, such departments appeared in Kyiv, Kharkov, Kazan. But special merit in the development of pathophysiology as a science belongs V.V. Pashutin, as already noted, in 1874 at Kazan University headed first in Russia Department of Pathophysiology and formulated the tasks of the new science. These reorganization measures made it possible to study various pathological processes in dynamics, which is possible only by observing its development in a living organism, i.e. in the experiment. So here it is pathophysiology and implies widespread use of the experiment, which is distinguishes our discipline from pathological anatomy. Pathophysiology is closely related to clinical disciplines At least because subject study both our science and clinical is illness, sick person. But research methods are different. The clinic sees individual patient man with specific manifestation of some pathology.. The clinic of internal diseases studies the causes, symptoms, course features, methods of treatment and prognosis of such diseases as, for example, hr. glomerulonephritis, acute hepatitis, pneumonia, etc. Neurological clinic - encephalomyelitis, stroke, meningitis, etc. All these are different diseases, different localization, symptoms and prognosis. And at the same time, there is something in common between them - each disease is based on a typical pathological process - inflammation, in the development of questions of the causes and mechanisms of its development, a significant role belongs to pathophysiology. Another example is that almost every clinical discipline deals with malignant neoplasms. To diagnose stomach cancer, brain tumors, skin tumors, you need to know how they differ from each other. Their course and prognosis are different. But for the successful treatment of this pathology, its prevention, a detailed study of the causes and mechanisms of the transformation of a normal cell into a malignant one is necessary, and they are the same for all oncological diseases. The study of these general patterns is what pathophysiology is engaged in. Thus, pathophysiology in relation to special clinical disciplines looks like a science that studies issues common to all diseases or a large group of diseases.. Without knowledge of the general patterns of occurrence and development of a particular pathological process, diseases, it is almost impossible to understand the whole variety of clinical manifestations of individual diseases. The particular is known through the general. The ability to explore the fundamental issues of pathology in this aspect, pathophysiology allows its main research method - method of modeling pathological processes and diseases

1.5. Method for the study of pathophysiology.

The method of modeling pathological processes and diseases is used by pathophysiologists in several of its varieties. I. Method of experiment on living objects. The meaning of the experiment is to reproduce the pathological process, the disease on various animals (individual organs, tissues, cells, subcellular structures), to study the patterns of its (her) development and conduct experimental therapy. This method allows you to monitor the development of the pathological process from the moment of its occurrence to completion. An experimental model of a disease is always simpler than a human disease. This makes it possible to divide the disease into a number of elements in order to reconstruct it in the future in relation to a person. At the same time, it should be borne in mind that no animal model of a disease, nor its individual elements, can be equivalent to a human disease. It is necessary to interpret the data of the experiment on the human body with a certain degree of certainty. Sometimes you can hear such a statement about pathophysiology that this science is built on experiments on animals, and it has nothing to do with human pathology. But not a single pathophysiologist conducts an experiment for the sake of an experiment and mechanically transfers its results to a person. They are always mindful of the limitations anisomorphism ( species differences in the structure and properties of animal and human organisms, individual organs and tissues). Anisomorphism, restrictions connected with deontological aspects experiments on animals (causing them physical suffering) and significant difficulties in animal reproduction social factors of disease all this limits using this method. Nevertheless, more significant discoveries in medicine have been obtained in experiments on living objects, and this method is the leading one for pathophysiology. All experiments are divided into acute and chronic, the use of each of them is determined by the purpose of the experiment. For example, when studying the mechanisms of traumatic shock, acute experience is needed, while the pathogenesis of atherosclerosis requires chronic experience. To study pathological processes, the following main methods are used:

shutdown method - removal or damage to an organ (surgical, pharmacological, physical, mechanical). This technique have been used for a long time. With the help of it, for example, it was possible to establish that diabetes mellitus, its development, is associated with a violation of the function of the islet apparatus of the pancreas. Removal of one of the paired organs (kidney) made it possible to study the compensatory and plastic possibilities of the remaining organ.

irritation method - by various influences, the functions of various organs are changed. Irritation of the vagus nerve causes bradycardia. Irritation of the sympathetic nerves revealed narrowing of the arteries, which served as the basis for the inclusion of this link in the pathogenesis of spontaneous gangrene in humans.

The "inclusion" method is the introduction of various substances into the body (hormones, enzymes, tissue extracts, biologically active substances, etc.). Then, the obtained results are compared with the results of similar effects in various human diseases. For example, with the introduction of allergy mediators, symptoms of the development of anaphylactic shock are observed.

method of comparative pathology - the study in the comparative "evolutionary" aspect of various pathological processes (fever, inflammation, hypoxia). A correct scientific analysis of human reactions to pathogenic effects requires a more complete knowledge of the ways and forms of their formation in the evolution of the animal world. II Mechnikov brilliantly revealed the significance of this method in the study of inflammation and resistance to infectious processes.

There are other experimental methods: the method of isolated or "surviving" organs, the method of tissue cultures, etc. Each experiment consists of several stages: 1. Formation of a working hypothesis. Any experiment should be preceded by a hypothesis, an idea, by checking which the researcher should get an answer to a particular question. You can’t conduct an experiment in the hope that something interesting will suddenly turn out, I.P. Pavlov said: “ If not in my head ideas, you will not see the facts". 2. Determining the goal and setting the objectives of the experiment. Having decided on the working hypothesis, it is necessary to formulate the goal and objectives by which it can either be proved or rejected. 3. The choice of private methods adequate to the tasks. When performing an experiment, the correct choice of a particular technique is important - an adequate selection of animals, the form of implementation (acute or chronic experience), the use of appropriate instruments, tools, etc. Necessary condition is also to ensure appropriate control. It can be an “empty” experience, when an experimental animal is injected, for example, with histamine, and a control animal is injected with physiological NaCl solution, or, the thyroid gland is removed from one animal, while a “sham” operation is performed on the control animal, etc. As for the particular methods of research themselves, the following should be noted here. The name of our discipline contains the word "physiology", but this does not mean that pathophysiologists are not interested in biochemical, immunological, biophysical and other mechanisms of disease development, that they are not allowed to use morphological methods. Pathophysiology, as we have already established, is a science that studies the causes, mechanisms of development and outcomes of a disease, and any technique that allows one or another to answer these questions can be applied. All this determines the omnivorousness of pathophysiology in a methodical sense - it uses physiological, biochemical, genetic, morphological, immunological and other research methods. 4. Conducting an experiment (series of experiments with control). A living object is a complex "open" biological system. It cannot be protected in any way from random influences of the environment (temperature, humidity, electromagnetic radiation, etc.), which can distort the results of the experiment. It must also be remembered that animals that are identical at first glance differ in hereditary characteristics and individual reactivity. Therefore, the researcher is not immune from the answer, distorted by a significant number of additional, random influences. All this must be taken into account and, if possible, eliminated. The experiment involves phase actions:

physiological phase- any experiment begins with the determination of the normal performance of a particular system, organ, on which the pathological process is supposed to be modeled. This also applies to control. For example, when studying the effect of adrenaline on the activity of the heart, the number of heartbeats is initially calculated not only in the experimental, but also in the control animal;

pathophysiological phase- after determining the normal vital signs of an intact animal, the pathological process is reproduced on it in accordance with the goals and objectives of the experiment;

experimental therapy phase- often, after the second phase, the researcher, using various methods of treatment, seeks to return the state of the experimental animal to its original state. A positive result confirms the working hypothesis and is the basis for the development of pathogenetic therapy.

5. Recording and analysis of experimental data. At the end of the experiment, the study continues: the results of the changes are evaluated vital functions experimental and control animals. They are grouped into tables, graphs, diagrams, etc. Morphological, biochemical, immunological and other studies are carried out on animals taken during life and (or) after death. The digital material is subjected to statistical processing in order to establish the average values, deviations from them, differences between average values and their reliability. 6. Discussion and conclusions. This is one of the most responsible and difficult stages of the experiment. The experimenter must explain the mechanism of change in certain functions of the organism according to the experimental data obtained and draw certain conclusions. For example, why does the amount of prostaglandins change when modeling inflammation, what is the mechanism for their increase, why does this group of biologically active substances have both pro-inflammatory and anti-inflammatory effects, which is decisive in the formation of these mechanisms that are diametrically opposite in effect? Does this only have a pathological significance, or are there elements of a defensive reaction here as well? If so, then again, you need to explain why? As you can see, there are continuous questions that the pathophysiologist must answer. And this is only one of the numerous groups of biologically active substances that play an important role in the development of the inflammatory process. Moreover, other violations are also noted - the permeability of microvessels changes, their patency, edema is formed in the focus of inflammation, etc. And this must be explained! It is possible to represent even such an equation as an abstraction (the identity ); pathophysiology = ???…?, that is, a science that constantly answers certain questions of human pathology. II. Method of clinical research. We have already talked about clinical pathophysiology, its significance and tasks. The further development of this section of our science will make it possible to significantly weaken the limitations that researchers experience when conducting experiments on animals. Sh. Methods of physical and mathematical modeling with the use of modern computer technology have great prospects. The construction of mathematical models of diseases is carried out when it is possible to connect by mathematical relations the main parameters of the object under study and the conditions that determine the possibility of its functioning - a model of the cardiovascular system, the heart itself, the respiratory system, etc. Modern computer technology makes it possible to model various pathological processes, to study the mechanism of their development, to predict the course and outcome. However, it should be noted that this method cannot fully replace animal modeling (it is impossible to represent a complex biological object in the form of mathematical symbols in full). Therefore, their confirmation in animals is often required. IV.Method theoretical analysis research results, formulation of scientific positions and concepts. At present, a large amount of factual material has accumulated in various branches of medicine, which determines the paramount importance of theoretical developments of methodological aspects of pathology. This includes issues of fundamental concepts and categories, the systemic principle in pathology, etc., related to the creation of the provisions of the general theory of medicine, which has not only theoretical but also practical significance.

TASK FOR SELF-CONTROL OF KNOWLEDGE.

1. What is the most complete definition: pathophysiology is: 1) the science of the vital activity of a diseased organism; 2) a science that studies the most general patterns of occurrence, development and outcomes of pathological processes, typical pathological processes and diseases; 3) a science that studies the causes and mechanism of development of pathological processes, typical pathological processes and diseases. 2. The subject (object) of the study of pathophysiology is: 1) animal diseases; 2) human diseases; 3) causative factor; 4) the relationship between the causes and conditions for the occurrence of diseases. 3. The tasks of pathophysiology include: 1) the study of typical forms of violation and restoration of the functions of individual organs and systems of the body; 2) formation of medical thinking; 3) study of typical pathological processes; 4) study of the etiology and pathogenesis of the disease in a particular patient. 4. Pathophysiology consists of the following main sections: 1) general nosology; 2) the doctrine of etiology; 3) the doctrine of typical pathological processes; 4) the doctrine of the general mechanisms of recovery. 5. General nosology includes the following subsections: 1) the general doctrine of the disease; 2) the doctrine of typical pathological processes; 3) the doctrine of pathogenesis; 4) the doctrine of etiology; 5) the doctrine of social aspects illness. 6. "General pathogenesis" considers: 1) general mechanisms for the development of diseases; 2) mechanisms of resistance of the organism to the action of pathogenic factors; 3) the basics of pathogenetic prevention and therapy; 4) main categories of damaging agents. 7. The main method for studying pathophysiology is: 1) the method of statistical processing of clinical data; 2) a method for modeling pathological processes and diseases; 3) method of mathematical modeling; 4) method of statistical processing of experimental data. 8. The main methods of experiment on living objects include: 1) the method of switching off; 2) stimulation technique; 3) method of biochemical research; 4) a method for studying functional indicators. 9. The main limitations of the experimental method on living objects are: 1) anisomorphism; 2) deontological aspects; 3) difficulties in reproduction of infectious diseases; 4) difficulties in modeling "social" pathology. 10. List the stages of the experiment in strict sequence: 1) defining the purpose and objectives of the experiment; 2) choice of private technique; 3) formation of a working hypothesis; 4) recording and analysis of experimental data; 5) conducting an experiment; 6) discussion and conclusions.

Pathophysiology passed hard way becoming. The development of pathophysiology, scientific and practical medicine are closely interdependent processes. This is what determined the origin of pathophysiology in the past (when it was referred to as "general pathology") and significantly affects its development at the present time.

Changed the name and place of pathophysiology in the system of training doctors and in medical science, but there has always been and continues to be a need for it as an integrating and analytical scientific specialty and academic discipline. This is due to the fact that it is pathophysiologists who are engaged in identifying, describing and explaining the causes, conditions, specific and general mechanisms of occurrence, development, as well as the outcomes of diseases and disease states. Based on this knowledge, the principles and methods of their diagnosis, therapy and prevention are developed and substantiated.

At present, the term "pathophysiology"» is used to designate a section of medicine and biology that studies and describes specific mechanisms and general patterns of the onset, development and completion of diseases and pathological processes; formulating the principles and methods of their diagnosis, treatment and prevention; developing a general doctrine about the disease and the sick person.

PATHOPHYSIOLOGY— SECTION OF MEDICINE AND BIOLOGY,

studies and describes the specific causes, mechanisms and general patterns of occurrence, development and completion of diseases, pathological processes, conditions and reactions;
formulates the principles and methods of their detection (diagnosis), treatment and prevention;
develops the doctrine of the disease and the diseased organism, as well as theoretical positions medicine and biology.

Subject (object) of study of pathophysiology

is not homogeneous and includes three components: "disease", "typical pathological process" and "typical form of pathology". All components of the subject "pathophysiology" (both as a science and as an academic discipline) are studied and described from the standpoint of the etiology and pathogenesis of diseases or pathological processes, their manifestations and mechanisms of development, the principles of their diagnosis, treatment and prevention.

Tasks.

Pathophysiology develops the problems of the etiology and pathogenesis of diseases, the mechanisms of their manifestations, formulates the principles of diagnosis, treatment and prevention of diseases.

Etiology.

Pathophysiology finds out, describes and explains the causes and conditions for the occurrence of diseases, disease states and pathological processes. Knowledge of these factors allows us to answer the question "why does it occur?"

Pathogenesis.

Pathophysiology explores, describes and explains the mechanisms of development of diseases and pathological processes, the mechanisms of their manifestations. This makes it possible to answer the question "How does it develop?" disease or pathological process.

Diagnostics.

Pathophysiology formulates and substantiates the principles and methods for the detection (diagnosis) of diseases and pathological processes. The solution of this problem is based on the knowledge of the mechanisms of occurrence, development and completion of diseases and pathological processes. This makes it possible to scientifically substantiate a rational scheme of diagnostic search for each specific patient, i.e. answer the question "how to detect?" disease or pathological process.

Treatment and prevention.

Pathophysiology formulates and argues the principles and methods of treatment, as well as the prevention of diseases and pathological processes, i.e. answers the question "how to treat and prevent?" disease.

Methods.

In pathophysiology, both in science and in an academic discipline, the following classes of methods are used: modeling, theoretical analysis, clinical research, as well as methods of other biomedical disciplines (biochemical, morphological, biophysical, statistical, etc.). All these classes of methods make it possible to obtain objective information about the etiology, pathogenesis and manifestations of diseases and pathological processes in each individual patient, as well as under experimental conditions.

Sections.

Pathophysiology includes three main sections: general nosology, the doctrine of typical pathological processes, and the doctrine of typical forms of pathology of tissues, organs and their physiological systems.

General nosology and the doctrine of typical pathological processes are referred to as "general pathophysiology", and the doctrine of typical forms of pathology of tissues, organs and their systems, as well as individual nosological forms - "private pathophysiology".