Mixed dystrophy Disturbances of the metabolism of the complex proteins icon

Mixed dystrophy Disturbances of the metabolism of the complex proteins




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Mixed dystrophy

Disturbances of the metabolism of the complex proteins

Importance of the theme: the mixed dystrophies are the morphological manifestations of the disrupted metabolism, which are localized both in parenchyma and in stroma and in the walls of vessels. In the cells of parenchyma and in the stroma appear the products of the metabolism of complex proteins (nucleoproteins, chromoproteins and lipoproteins). Complex proteins play very important role in the life of organism, with their aid are carried out many different functions like the processes of tissue respiration (hemoglobin and cytochromes); the production of secretion (bile and serotonin); protection from ultra violate rays (melanin) and others. The disturbances of the metabolism of these substances are the basis of many illnesses and are studied in different clinical departments.

Purpose (general): to know how to recognize the morphological special features of the different types of the mixed dystrophies, at basis of which lies the disturbance of the metabolism of complex proteins, and to determine their reasons, pathogenesis, and the outcomes of each process and its value for the organism.

The specific goals:                                         

To know how

Purposes of the initial level

1. To determine the gross and microscopic signs of hemosiderosis in general and local manifestation, to explain their reasons, pathogenesis and their value to the organism

1. To know the mechanism of hemosiderin formation. The origin of sideroblast and the role of siderophage (department of biochemistry).

2. to determine the morphological manifestations of bilirubin metabolic disturbances, i.e. the forms of jaundices, their pathogenesis, to explain reasons and value to the organism

2. to know the special feature of the metabolism of bilirubin, the place of its formation, its quantity in blood, the path of excretion from the organism (department of biochemistry). To recognize the extra-hepatic bile ducts (department of general anatomy)

3. to determine the signs of the melanin metabolic disturbances, reasons and the pathogenesis of their appearance

3. To explain the physiological role of melanin and the regulation of its metabolism (department of biochemistry)

4. To determine the morphological manifestations of gout and urate of diathesis and to explain the value of these processes

4. To explain the paths of nucleoproteins metabolism (absorption, synthesis and excretion from the organism) (department of biochemistry)



In order for you to clarify the initial level of your knowledge, we propose to review the following home tasks for self-verification and self-control.


Task №1: A tumor of common hepatic duct which reduced its lumen was found in a patient with mechanical jaundice. Indicate where the stagnation of bile will not be observed.

1. Common hepatic duct

2. Right and left hepatic ducts

3. Interlobar, interlobular, intra-trabecular and intercellular ducts

4. Common bile duct

Task №2. It is known that at the basis of gout lie in the nucleoproteins metabolic disturbance. the end product of the purine bases metabolism accumulates in tissues. Indicate this end product?

1. Urea

2. Creatinine

3. Uric acid

4. Cholesterol

5. Bilirubin

Correct answers to the tasks are: 1-4; 2-3

Resources to assist you in preparing for the initial level of knowledge:

1. Increase in weight M.G., Lysenko N.K., Bushkovich V.I. // the anatomy of man. - “Hippocrates”,  2001, s.282-285, 322-334.

2. Afanasev YU.M., Yurina I.A. // histology, cytology and embryology. - G., medicine, 1999, s.597-607, 671-672.

3. Is birch T.T., Korovkin B.F. // biological chemistry. - G. - Medicine, 1990. - s.65-89, 369-399.

Theoretical questions.

1. Hemoglobinogen pigments, their origin and some properties.

2. Hemosiderosis, general and local; reason, pathogenesis, morphological manifestations.

3. Jaundices, their classification, reasons and the pathogenesis of each of them.

4. Disturbances of ferritin metabolism, hematoidine, hemomelanin and hematin; their reason and their value to the organism.

5. Disturbances of melanin metabolism, local and general melanosis. Addison's disease. Examples of hypomelanosis (albinism, innate and acquired leykoderma).

6. Disturbances of lipoproteins metabolism (lipofuscin, lipochromes, steroids).

7. Disturbance of nucleoproteins metabolism. Pathogenesis and morphology of gout, diathesis urate .

Literature for mastering the necessary knowledge of this theme.

1. Strukov A.I., Serov explosives. // pathologic anatomy. - Kharkov, “fact”, -1999. - s.90-108.

2. Lectures of department on the theme “the mixed dystrophias. Formation of stones ".

3. Graph of the logical structure of theme “mixed dystrophias” (application of № 1).

4. Algorithm of morphological diagnostics of the disturbance of the metabolism of chromoproteins (application of № 2).

Additional literature:

1. Serov explosives, Yarygin A.D., spiders V.S. // pathologic anatomy. Atlas. - G. Medicine. - 1986. - s.43-59.

2. Shlopov V.G. // the bases of the pathologic anatomy of man. - Kiev, 1999. - s.62-77.

3. Shlopov V.G. Pathologic anatomy: Textbook. - Vinnitsa: NEW BOOK, 2004. - 768 s.

Review the following purposeful tasks.

Task № 1: During a study of a hemorrhage focus the pathologist concentrated on the presence of golden yellow pigment in the cytoplasm of macrophages and assumed that this hemorrhage occurred not less than 24 hours ago. What pigment is discovered?

^ 1   hemosiderin;

2   hematoidine;

3   hematin;

4   lipofuscin;

5   bilirubin.

Task №2: A woman arrived to the hospital after she was bitten by a blunt nosed viper (poisonous snake). She suffered a sharply pronounced hemolysis. Despite the intensive therapy, she died on the 7th day of her arrival. An autopsy of the spleen, bone marrow and lymph nodes showed brown staining. Microscopic examination of macrophages cytoplasm showed a positive Perls stain pigmentation. Identify the pigment discovered?

1. Hemosiderin;

2. Hematoidin;

3. Hematin;

4. lipofustsin;

5. melanin.

Task №3: A sepsis patient has an icteric staining of scleras and skin. What pigment caused this staining of the skin?

1. hemosiderin;

2. hemoglobin;

3. hemomelanin;

4. bilirubin;

5. hematoidine.

Task №4: A 32 y.o woman had a temperature of 38 degrees, yellow stained skin, sclera and mucus. Blood laboratory investigation showed increased direct and indirect bilirubin. Liver biopsy showed signs of hepatitis, cellular dystrophy of the hepatocytes. What process is discovered?

1. Hemochromatosis;

2. Hemolytic jaundice;

3. Paranchymal jaundice;

4. Obstructive jaundice;

5. Hemomelonosis.

Task №5: A Woman with gallstone disease for several years arrived to the surgical department with severe pain in RUQ. She had icteric Skin, mucus and sclera. She had a strong itch. During surgery she showed dark brown coloration of hepatic duct. What pigment caused these changes?

^ 1   Direct bilirubin;

2   indirect bilirubin;

3   Direct and indirect bilirubin;

4    hemosiderin;

5    hematoidine.

Task №6: Young woman had a discoloration of skin resembling bronze suntan. Examination revealed, besides hyperpigmentation, double sided tuberculosis of the adrenal glands. What pigment caused the color of the skin?

1. hemosiderin;

2. direct and indirect bilirubin;

3. hemomelanin;

4. melanin;

5. hemin (hydrochloric acid hematin).

Task №7: An alcoholic woman with an inactive life style and a family history of obesity complains about pain and deformation in her joints. Symptoms were due to stones in those joints. What illness caused those symptoms?

1. obesity;

2. diabetes mellitus;

3. Primary gout;

4. Secondary gout;

5. Cardiac infarction.

Task №8: autopsy of a man with chronic tuberculosis had reddish brown staining of myocardium. Microscopic examination of cardiomyocytes cytoplasm revealed a free golden brownish pigment. The metabolism of what pigment is disrupted?

1. bilirubin;

2. hemosiderin;

3. hemomelanina;

4. lipofuscin;

5. melanin.


Task №9: A tropical malaria patient fell into the comatose state and through several hours died. An autopsy revealed a discoloration of the gray substance of the brain by slate- gray (smoke-colored) color. The disturbance of the metabolism of what pigment occured in this case?

to 1.hemosiderin;

to 2.lіpofustsin;

to 3.hemomelanіn;

to 4.melanіn;

to 5.hematoporfіrin.

Task №10: A patient, who for a long time suffered from a rheumatic heart defect, showed a phlegm “rusty” color. laboratory investigation showed alveolar macrophages , which contain in the cytoplasm hemosiderin ( “the cells of heart defects ”). What pathologic process their appearance?

1. General Hemosiderosis;

2. Local hemosiderosis;

3. Hemolytic jaundice;

4. Paranchymal jaundice

5. Obstructive jaundice.

students instructions for the practical class “Mixed dystrophies. Disturbances of the metabolism of complex proteins ".

Start by verifying the right answers of the home tasks. Then Check your preparation by answering the tests. Independently observe the microspecimens “brown indurations of lungs", “hemosiderosis of spleen ", “liver with obstructive jaundice ". It is necessary to study the following gross specimen “hemosiderosis of spleen ", “brown indurations of lungs ", “old hemorrhage in brain". use the chart of morphological diagnostics of the disturbances of the metabolism of chromoproteins (application of № 2), and also tables “brown induration of lungs ", “hemorrhage into the brain ".


Appendix №1

Graph of the logical structure of theme “The Mixed Dystrophy. Disturbances of the metabolism of complex proteins”

^

Mixed Dystrophy




Disturbance in chromoprotein metabolism




Classification of chromoproteins



Hemoglobinogen pigments

Proteinogenic pigments

Lipidogenic pigments






Hemosiderosis



Local

General


Causes

Localization

Cause & Pathogenesis

Localization





Hemorrhage

Intravascular Hemolysis

Lymph Nodes

Spleen


Place of hemorrhage, lungs


Bone Marrow

Venous plethora of the lungs


Disturbances of the exchange of bilirubin - jaundice



Classification of jaundice

Morphological manifestations



Suprahepatic

Hepatic

Infrahepatic

Yellow Discoloration

Manifestations of cholemia



Skin, sclera, internal organs

Hemorrhagic syndrome; dystrophy of internal organs, coma, necrosis of the epithelium of kidneys ducts

Etiology

Etiology


Etiology

Infection, intoxication, the transfusion of incompatible blood

Hepatitis, dystrophy, the necrosis of the hepatocyte

stones of bile tracts, cancer of faterova of nipple, cancer of the head of the pancreas, cholangitis



Hemolysis


Disturbances of the exchange of melanin


Depigmentation

Hyper-pigmentation


Local

General

Local


General



Disturbances of the exchange of nucleoprotieds



Gout

Uric acid diathesis

Appendix №2

Chart of morphological diagnostics chromoproteins metabolic disturbances



Light of dense consistency with the rusty nuance

Lymph nodes and the spleen of rusty color

Skin, sclera, the internal organs of the yellow

Auger- brown or dark sunburn the color of the skin

On the skin of the spot of the brownish color








The presence of brown pigment in siderophage, which are located in the opening of alveoli and the interalveolar septa

Deposits of hemosiderin in the macrophages of lymph nodes and spleen sinuses

Deposits of melanin in the cells of the basal layer of the epidermis

Deposits of melanin in the cells of the basal layer of the epidermis








Local hemosiderosis

General Hemosiderosis

Jaundice

Hyper-pigmentation by melanin (general)

Local hyper-pigmentation








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