Local disorders of circulation. Thrombosis. Embolism icon

Local disorders of circulation. Thrombosis. Embolism




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Local disorders of circulation. Thrombosis. Embolism.

Relevance: Local disorders of circulation, arterial and venous hyperemia, stasis hemorrhage and apoplexy, thrombosis, embolism, are very common in different illnesses.

Some of which, like thrombosis, thromboembolism hemorrhage, can characterize denominate abnormalities of function of different organs and systems, they can also lead to a patients death.

Understanding the substance of causes, mechanisms of development, morphologic changes, meaning of these processes is necessary for their PM (preventive maintenance), choosing the right tactics of treatment, prognosis of course of illness and possible complications.

Knowledge and skills that are acquires in this class, are essential, in order to understand further divisions of pathologic anatomy, some clinical disciplines and a successful medical practice, for doctors of any specialties.

Objective: to be able to determine by macro and microscopic signs different types of local disorders of circulation, to understand the causes and mechanisms, their consequences and meaning for the organism.

^ Specific objectives: Objectives of primery state:

To know how to:

1. Recognize macro and microscopic manifestations of local arterial hyperemia, to explain the causes, mechanisms, complications and estimate their meanings.

1.Understand the anatomy of the cardio-vascular system, factors that ensure its normal functioning.

2. Recognize macro and microscopic manifestations of local venous hyperemia, explain the causes, mechanisms, complications and estimate their meanings.

2. Understand the features of perfusion of heart, kidneys, brain, organs of abdominal cavity.

3. Recognize macro and microscopic manifestations of different types of hemorrhages, explain their causes, mechanisms, complications and estimate their meaning.

3. Understand the normal microscopic structure of arteries, vanes, vessels of microcirculation, the normal angioarchitecture of organs, normal perfusion of organs.

4. Recognize macro and microscopic structure of thrombus, explain its causes, conditions and mechanism of its formation, possible complications and estimate the meaning. Recognize and differentiate thrombus and post mortal blood coagulations based on macro and microscopic manifestations.

4. Understand the communications between coagulation and anticoagulation systems in order to provide homeostasis, mechanism of coagulation.

5. Define different types of embolisms, causes, pathogenesis, estimate its meaning and prognosis.






Here are some test questions, in order to test your initial knowledge.


1. Choose the feature that characterizes an artery but not a vein.

1. A vessel wall is made of 3 layers.

2. The inner layer is lined of endothelium.

3. A round clearance of a vessel.

4. The middle layer is thinner then the external.

5. Well-defined inner elastic membrane.

2. A patient, with a catheterized left sub clavicular vein, arised a thrombus, a fragment of which had detached of it. Where will the fragment flow?

1. Jugular vein.

2. Pulmonary veins.

3. Sinuses of dura mater.

4. Pulmonary artery.

5. Aorta.

3. From the following, choose an elastic type artery.

  1. A. вrachialis

  2. A. femoralis

  3. A. carotis communis

  4. A. intercostalis

  5. A. splenica.

4. A patient has a disorder of fibrinogen synthesis, because of toxins action. What blood function is damaged?

1. Trophic.

2. Coagulative.

3. Respiratory.

4. Transporting.

5. No function is damaged.

The correct answers : 1-5 ; 2-4 ; 3-3 ; 4-2.

All the necessary information, you can find in the following textbooks.

  1. Prives M.G., Lisenko N.I., Bushcovich V.I. – "Human anatomy". 2001

  2. Afanas'yev U.I., Yurina N.A. – "Histology, Cytology and Embryology". 1999

  3. Filimonov B.I. – "Normal physiology" – 1994



Theoretical questions which will help you prepare for the class.

1. Local arterial hyperemia: its definition, types, causes and mechanism of development, morphologic manifestations, complications and meaning.

2. Local venous hyperemia: its definition, types, causes and mechanism of development, morphologic manifestations, complications and meaning.

3. Stasis: its substance, causes, localizations, meaning.

4. Hemorrhage and apoplexy: definition, causes, mechanism of development, classification by a macroscopic features, possible complications and meaning. Hemorrhagic syndrome and its causes.

5. Thrombosis: definition, causes, mechanism of development, morphology and types of thrombus, their localization, possible complications, meaning of arterial and venous thrombus. DIC-syndrome.

6. Embolism: definition, types of embolism by their origin and their pathogenesis, types of embolisms by direction of movement.

7. Thromboembolism of pulmonary artery: causes, localization, clinical manifestations and meaning.

Literature for understanding and getting the right skills on this topic.

1.Strukov A.I., Serov V.V "Pathologic Anatomy" // Charkove 1999

2.Department lectures on the topic " Local Disorders of Circulation"

3.Graph of logical structure, topic "Thrombosis" (supplement№1).

4.Graph of logical structure, topic "Embolism" (supplement№2).

5.Algorithm of morphologic diagnostics of thromboses and post mortal blood clot (supplement№3).

Additional literature.

  1. Serov V.V., Yarigin N.E., Paukov V.S. "pathologic anatomy atlas" 1986

  2. Shlopov V.G. "Basis of human pathologic anatomy" // Kiyev, 1999



Answer the following questions.

Q.№1 On an autopsy of a 35 year old woman, whom suffered of a bacterial endocarditic with thromboses on the surface of the aortic valve, in the kidney there were found several areas, triangular shape, structureless, flabby consistency, white-yellow colour, the base of the triangle is facing the capsule. What was found in the kidney?

1.Local arterial anemia.

2.Hemorrhagic infarction.

3.Adipose dystrophy.

4.Ischemic infarction.

5.Colliquative necrosis.


Q.№2. On an autopsy of a 35 year old woman, whom suffered of a bacterial endocarditic with thromboses on the surface of the aortic valve, in the kidney there were found several areas, triangular shape, structureless, flabby consistency, white-yellow colour, the base of the triangle is facing the capsule. What most likely is the reason of these changes?

1.Angiospasm.

2.Thrombosis of renal artery.

3.Atherosclerosis.

4.Thrombosis of hepatic veins.

5.Thromboembolism oh renal arteries.


Q.№3. On an autopsy of a man, who had suffered from hypertension, under pia-mater was found a flabby, brown and grey blood clot, size 10x8x1.5cm, locally connected to the tunic. What type of apoplexy happened?

1.A petechia.

2.A bruise.

3.Hemorrhagic infiltration.

4.Hematoma.


Q.№4. A 48 year woman who had died 5 days after an operation on a malignant uteri tumor, the autopsy showed that in the lungs, under the pleura, were found a few triangular areas, flabby in consistency, dark red colour. What is the reason of these changes?

1.Atherosclerosis of pulmonary artery.

2.Thrombosis of bronchial artery.

3.Thrombosis of brunches of pulmonary artery.

4.Thrombo-embolism of brunches of pulmonary artery.


Q.№5. A 72 year old woman whom had suffered of coronary heart disease, and had died of cardiac failure, on her autopsy, in profound veins of the lower leg, was found a flabby blood clot attached to a vessel wall, oblong in shape, with a corrugated surface. What process was found in this case?

1.Postmortal blood clot.

2.Apoplexy.

3.Local venous hyperemia.

4.Thrombus.

5.Thrombo-embolism.


Q.№6. On an autopsy of a man, who had died of a bladder tumor, in a few places in the pulmonary artery, were found blood clots, oblong shaped, flabby consistency, dark red in colour, that freely lie in the artery, closing the opening. What type of circulation disorder is in this case?

1.Stasis.

2.Thrombus.

3.Postmortal blood clot.

4.Thrombo-embolism.

5.Local arterial hyperemia.


Q.№7. On an autopsy of a man, who had died of a bladder tumor, in a few places in the pulmonary artery, were found blood clots, oblong shaped, flabby consistency, dark red in colour, that freely lie in the artery, closing the opening. Choose a possible complication of this process?

1.Local venous hyperemia.

2.Dystrophic changes.

3.Local anemia.

4.Local atrophy.

5.Organization.

Methodic instructions for students for a class "Local disorders of circulation"

In the beginning of the class, your homework will be checked. Then you will be tested on how well have you prepared for the class.

Individually you should study the macro and micro specimens and answer the questions.

The appearance of thrombus, thrombo-embolisms and post mortal blood clots, you may study from the following microslides: "Thrombosis of femoral vein", "Thrombosis of the Aorta", "Thrombosis of the venous sinus of dura mater", "Globular thrombus of left atrium", " Thormbo-embolism of pulmonary artery", "Postmortal blood clot". The macroscopic appearance of hemorrhages are studied on the following: "Apoplexy in to the brain, with a hematoma", "Subarachnoid hemorrhage", "hemorrhagic infiltration of паранефральной клетчатки”, "Cyst on a hemorrhage in the cerebrum".

The microscopic structure of thrombus is studied on the following microslides: "Thrombosis of a crus artery", "Thrombosis of a crus vein", "Thrombo-embolism of pulmonary artery", "Thrombosis of a vein during an organization".

Study the microslide "brain apoplexy". Using a table, microphotografs, study different types of embolisms. Use the information in the supplements.

The class is finished with an analysis of the students work, and a test control.


^ Technologic map of the class.



s/n

Period

Session (min.)

Educational visual aid, means of training

equipment

Place of holding

1.

Testing and correction of initial state.

5

Multiple choice questions




Study room

2.

Individual work. Description of macro- and micro- preparations.

60

Supplements # 1,2,3. Algorithm of study macro and micro preparations.

Microscope, macro and micro preparations. Microphotographs.




3.

Self testing and correction of the learned material.

30

Target educational tasks







4.

Final test control

15

Test collection







5.

Summery of the class

10












Supplement №1
^

Graph of logical structure "Thrombosis"



Thrombosis






Conditions for thrombosis

Causes


Hemodynamic disorder

Endothelium disorder

Disorder in physicochemical features of the blood


Mechanism

Morphology of thrombus






Macro

Micro








Complications

Meaning








Septic disintegration

n



Resorption


Organization


Recanalization


Petrification



Supplement №2
^

Graph of logical structure "Embolism"



Embolism

Types of embolism












Types of movement











Meaning

Complications





Supplement №3




Algorithm of morphologic diagnostics of thrombosis and postmortal blood clot




Macroscopic

Blood clot is flabby, dry, has a rough, corrugated surface

Blood clot is elastic, smooth sparkling surface


Relevance to vessel wall

Always attached to vessel wall

Never attached to vessel wall


Microscopic

Has a laminar structure, the layers are made of thick fiber of fibrinogen and blood cells

Made of thin fibrinogen fiber and blood cells. Has a netlike structure


Diagnosis
Thrombosis
Postmortal blood clot








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