Local circulation disorders. Ischemia, infarction icon

Local circulation disorders. Ischemia, infarction




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Local circulation disorders. Ischemia, infarction.

Relevance: Local circulation disorders – local anemia (ischemia) and infarction, are very common with a lot of diseases, some of them (myocardial infarction, brain infarction) have such a large medico-social meaning, that it had enables to extract them to a separate nosological units, acute ischemic heard disease, cerebro-vascular disease. These diseases lead among all others in fatality.

Understanding the essence of causes, mechanisms of development, morphologic manifestations, meanings of these processes for the macro-organism, is essential in order to prevent, diagnose them, choosing the right tactics of treatment, prognosis of possible complications.

Knowledge and skills received in class, will help you understand the upcoming divisions of specific pathologic anatomy, clinical disciplines, and also your medical practice


Objective: to determine by macro and microscopic changes ischemia and infarction. Understand their causes, mechanisms of development, to estimate possible complications and meanings of these processes.


^ Specific objectives Initial state objectives

To know how to:

1. Determine macro and micro manifestations of ischemia.

1. Understand to normal anatomy of cardio-vascular system. Factors needed for its normal functioning.

2. Explain the causes of ischemia, mechanism of development, estimate its meaning and prognosis, possible complications.


2. Understand the features of heart circulation, kidney, brain, abdominal cavity organs circulation.

3. Determine by macro and microscopic picture different types if infarction.

3. Recognize the normal microscopic structure of arteries, veins, and vessels of microcirculation. Normal architectonics of organs, normal state of perfusion.

4. Explain the causes of infarctions, mechanism of development, possible outcomes and estimate its meaning.







Here are some questions to test your initial knowledge.

1. 62 year old male, has an acute transmural myocardial infarction of lateral wall of left ventricle. What artery is more likely had clotted in this case?

1. Left frontal descending coronary artery.

2. Pulmonary artery.

3. Left enveloping coronary artery.

4. Left subclavicular artery.

5. Right coronary artery.

2. From the following, choose a variant in which all the organs have a double system of blood supply or highly developed collateral vessels?

  1. Liver, bowel, heart.

  2. Medulla oblongata, lungs, bowel.

  3. Kidneys, spleen, lungs.

  4. Lungs, liver, pancreas.

  5. Heart, spleen, medulla oblongata.

3. From the following, choose a variant that characterizes an artery but not a vein.

  1. A vessel wall is made of 3 layers.

  2. Inner tunic is lined with endothelium.

3. Existence of valves.

4. Middle tunic is thinner then the external.

5. Well-defined inner elastic membrane.

The correct answers: 1-3, 2-2, 3-5.


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


Theoretic questions to help you prepare for class.

  1. Local circulation disorder (ischemia): definition, causes, types, possible outcomes, complications and meaning.

  2. Role of factors such as collateral circulation (existence, efficiency of cardio-vascular system, speed of appearance of ischemia), type and metabolism of tissue in which the ischemia had acquired, stage of ischemia, duration.

  3. Infarction: definition, causes, conditions of appearance.

  4. Types of infarctions, their morphology, pathogenesis of anemic and hemorrhagic infarctions, possible outcomes and meaning.

  5. Causes, morphologic features, outcomes and meanings of myocardial infarction.

  6. Causes, morphologic features, outcomes and meanings of lung infarction.

  7. Causes, morphologic features, outcomes and meanings of brain infarction.

  8. Causes, morphologic features, outcomes and meanings of bowel infarction.


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 "Infarction" (supplement №1).

4.Algorithm of morphologic diagnostics of infarction (supplement №2)

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



Here are some questions to test your knowledge.

Q.№1. A 37 year old male was hospitalized with an acute pain in the abdomen. During surgery was found that about 50cm of the small intestine is dark red, the Serosal tunic in this area is grayed out, in the abdominal cavity a small amount of hemorrhagic fluid. What type of circulation disorder is in this case?

1. Hemorrhage.

2. Local venous hyperemia.

3. Local arterial hyperemia.

4. Stasis.

5. Hemorrhagic infarction.

Q.№2. During an operation on a 68 year old man, who was hospitalized with an acute pain in the abdomen. During surgery was found that about 75cm of the small intestine is dark red, the Serosal tunic in this area is grayed out, in the abdominal cavity a small amount of hemorrhagic fluid. What complication we are more likely to expect?

1. Aseptic autolysis.

2. Septic disintegration.

3. Organization.

4. Petrification.

5. Encapsulation.

Q.№3. On an autopsy of a 35 year old woman, who had suffered from bacterial endocarditis with clots on the surface of the aortic valve, in the kidney were found several areas triangular form, structureless, flabby, a white-yellow colour, the basis of the triangular is towards the capsule. What does the finding tells us?

1. Local arterial anemia

2. Hemorrhagic infarction.

3. Adipose dystrophy.

4. Ischemic infarction.

5. Colliquative necrosis.

Q.№4. On an autopsy of a 46 year old woman, who had suffered from bacterial endocarditis with clots on the surface of the aortic valve, in the kidney were found several areas triangular form, structureless, flabby, a white-yellow colour, the basis of the triangular is towards the capsule. What is most likely to have caused these changes?

1. Angiospasm.

2. Thrombosis of kidney artery.

3. Atherosclerosis.

4. Thrombosis of kidney vein.

5. Thromboembolism of kidney artery.

Q.№5. A 58 year old woman, who had died on the 6th day after her surgery of a malignant tumor in the uterus, on the autopsy was revealed that in her lungs right beneath the pleura were found several areas triangular form, flabby, dark red colour. What process had developed?

1. Apoplexy.

2. Blood stasis.

3. Hemosiderosis of the lungs.

4. Hemorrhagic infarction.

5. Local venous hyperemia.

Q.№6. A 46 year old woman, who had died on the 5th day after her surgery of a malignant tumor in the uterus, on the autopsy was revealed that in her lungs right beneath the pleura were found several areas triangular form, flabby, dark red colour. What is most likely to have caused this?

1. Atherosclerosis of pulmonary artery.

2. Thrombosis of bronchial artery.

3. Thrombosis of a branch of pulmonary artery.

4. Thromboembolism of branches of pulmonary artery.


Q.№7. A75 year old patient suffers from lung emphysema with denominated cardio-pulmonary insufficiency, accompanied by edemas and ascites. During a puncture of the abdominal cavity, after eliminating 3.5 liters of transsudate, the patient had fainted. What have caused the patient to faint?

1. Venous hyperemia of the brain.

2. Venous hyperemia in the portal system.

3. Concentration of the blood.

4. Acute brain ischemia.

5. General anemia.

Q.№8. On an autopsy the coroner in the brain stem had found an area with well-defined borders, flabby consistency, and grey colour. The microscopic exam revealed a large amount of small hollow spaces and one big cavity, on the periphery of which were found a lot of macrophages, looking like adipose-granular balls. What did the coroner find?

1. Hydrocephaly.

2. Hemorrhagic infarction.

3. Ischemic infarction.

4. Brain edema.

5. A cyst after a hematoma.


Methodic instructions for students for a class "Local disorders of circulation, Ischemia, Infarction"

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.

Macroscopic types of infarctions you can study on the following macro specimen: "Fresh myocardial infarction", "Ischemic infarction of the spleen", "Ischemic infarction of kidney", "Hemorrhagic infarction of the lungs", "Hemorrhagic infarction of the bowel", "Myocardial infarction in stage of cicatrisation", "Authentic rupture of the heart", "Cicatrix in kidney after infarction".

Microscopic structure of infarction you can study on the following micro specimen: "Infarction of kidney", "infarction of spleen", "Myocardial infarction", "Grey softening of the brain", "Myocardial infarction in stage of cicatrisation", "Hemorrhagic infarction of the lungs".

Macro and micro specimen are studied using the tables, microphotographs. When studying this topic, use the added supplements.


^ 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.

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 "Ischemia. Infarction"



Infarction

Causes of ischemia

Types of infarctions

Type of necrosis






















Outcomes

Meaning






Organization

Petrification


Aseptic disintegration

Septic disintegration

Supplement №2
Instructions of studying macro specimens.

  1. Define the organ

  2. Size

  3. Shape

  4. Surface

  5. Consistency

  6. Colouring

  7. Picture on cut-set

  8. Characterize areas of changes

  9. Name the pathological process




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