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MINISTRY OF PUBLIC HEALTH OF UKRAINE

BUKOVINIAN STATE MEDICAL UNIVERSITY


Approval on methodological meeting

of the department of pathophisiology

Protocol №

Chief of department of the pathophysiology,

professor Yu.Ye.Rohovyy

“___” ___________ 2008 year.


Methodological Instruction

to Practical Lesson



Мodule 1 : GENERAL PATHOLOGY.

Contenting module 3. Typical disorders of metabolism.


Theme15: The disturbance of energy,

protein and basal metabolism. Starvation.


Chernivtsi – 2008

1.Actuality of the theme. For data of the WHO, more than half of population of globe chronically is undernourished. Therefore starvation is the social problem is considered not only as medical, but also as asocial problem. This pathological process accompanies with a number of diseases, mainly of digestive system. There is protein-calorie insufficiency more often.

The changes of metabolism for starvation are carried out nervous, endocrine and peripheral mechanisms of regulation. Due to such regulation there is a redistribution of nutritious substances for maintenance of functions of the vital bodies (heart, brain) and preservation of life on long time.

^ 2.Length of the employment – 2 hours.

3.Aim:

To khow: the disturbance of energy metabolism, the disturbance of basal metabolism, the disturbances of protein metabolism, the disturbance of transamination and oxidative desamination, the disturbance of decarboxilation.

To be able: to analyse of the pathogenesis of the starvation.

^ To perform practical work: to analyse the pathogenesis of the medicinal starvation (fasting). Now fasting is used as non - specific method of treatment of some disеаsеs including al1ergic, cardiovascular, cutaneous, obesities, and disеаsеs of the joints. Dosed starvation inсreases the рrосеssеs of disassimilation and promotes excretion of anу ехсеssеd and "slags". It is related first of al1 to pathological аdipose deposit salts, products оf metabolism. Тransferring the endogenous nourishment the organism expends it's own fats, carbohydrates and proteins. At the same timе restorative рrосеssеs increase, that leads to renovation, as though rejuvenation of the organism. The medicinal starvation has the same division into periods as pathologic, however the last сonсluding period is а period of сompensation, when the genera1 condition imрroves, the weakness disарреars, appetite арреars. Such difference from the pathologic starvation is connected with measures, carrying out during the medicinal starvation for the struggle with acidosis and excretion of "slags", which incrеаsе the pathologic manifestations in usual starvation.

4. Basic level.

The name of the previous disciplines


The receiving of the skills

  1. histology

  2. biochemistry

  3. physiology

Significance of proteins, fats, carbohydrates, water, vitamines for normal ability to live of an organism.

Mechanisms of neuro-humoral regulation of metabolism and energy.


^ 5. The advices for students.

1. Define basal metabolism.

Basal metabolism is a quantity of energy secreted by an organism in standard conditions (in rest, on an empty stomach, with the surrounding temperature of 18 °C)

2. How is basal metabolism regulated?

The nervous and endocrine systems participate in the regulation of basal metabolism. The nervous system controls the tissue and organ metabolism with the help of mediators (adrenaline, nor-adrenaline).

Emotional overstrain leads to elevation of heat production, carbohydrate metabolism and other changes. Many metabolic disturbances are stimulated by damage of the diencephalon. The role of the hypothalamus is especially important, because the influence on metabolism increases with the help of releasing factors through the pituitary body. Thyroxin, somatotropin, adrenaline, sex-hormones stimulate basal metabolism and intensify the energy processes.

3. What is starvation?

Starvation appears when:

1) the organism does not receive food at all

2) receives food in insufficient quantity or

3) when the organism does not assimilate it due to disease

^ 4. Classify types of starvation:

physiological

pathological

Hibernation in some mammals

Complete

Incomplete

Absolute

Non-absolute (ingestion of water)

Quantitative

Qualitative

5. ^ How does basal metabolism change in starvation?

Complete starvation can be divided into four periods as to its clinical manifestation:

1) Indifference

2) Excitement

3) Suppression

4) Paralysis and death

According to the peculiarities of metabolism and exchange of energy complete starvation can be divided into three periods:

1) uneconomical energy expense

2) maximum adaptation and economical energy expense

3) terminal period (paralyses and death)

6. Scheme of pathogenesis of nutritional deficiency diseases.

PRIMARY DEFICIENG — lack of essential nutrients. It happens during and after the wars, (dietary inadequacy) catastrophes, earth-quakes and others.

^ NUTRITION DEFICIENCY

TISSUE DEPLETION

BIOCHEMICAL LESIONS

FUNCTIONAL CHANGES

ANATOMIC LESIONS

SECONDARY DEFICIENCY

1) Gastroenteric diseases 2) Neuropsychiatric disorders 3) Congestive heart failure 4) Cancer therapy

5) Infectious diseases 6) Food allergy 7) Loss of teeth 8) Pregnancy, lactation

5.1. Content of the theme. What does the basal metabolism means? Define basal metabolism. How is basal metabolism regulated? What is starvation?How does basal metabolism change in starvation? Scheme of pathogenesis of nutritional deficiency diseases.


5.2. Control questions of the theme:

1.What does the basal metabolism means?

2. Define basal metabolism.

3. How is basal metabolism regulated?

4. What is starvation?

5. How does basal metabolism change in starvation?

6. Scheme of pathogenesis of nutritional deficiency diseases.


^ 5.3. Practice Examination.

Task 1.

In the patient arisen disbacteriosis of intestines. Synthesis of what vitamin is infringed?




A. Vitamin A B. Vitamin В C. Vitamin C D. Vitamin D Е. Vitamin K

Task 2.

In the woman in time of investigation the languid weak construction bile cyst after introduction 35 ml of vegetable oil in duodenum is revealed. What insufficiency hormon such state is connected with?




A. Gastrin B. Secretin C. Motilin D. Somatostatin Е. Cholecystokinin

Task 3.

In the patient was made resection of stomach connected with tumor. After some in him arisen anemia, which for features of picture of blood and bone marrow have attributed to В12-deficiency. What unsufficiency of active substance has become the reason of disease?




A. Pepsin B. Tripsin C. Gastrin D. Castle’s factor

Е. Hydrochloric acid

Task 4.

In the rat, which starvated during 5 days without water defined relative weight of different bodies. On this parameter the least loss of weight was observed from the party




A. Spleen B. Lungs C. Brain D. Muscles Е. Liver
^

Real-life situations to be solved:


After chemical burn in the patient was developed esophagal stenosis, that hindered reception of food. After that occured cachexia – weight of rhe body decreased on 16 %. Data assay of blood: erythrocytes – 3,11012/l, leucocytes – 5,2109/l, hemoglobin – 113 g/l, concentration of glucose – 3,7 mmol/l, contents of protein – 57 g/l.

1. What kind of starvation in the patient?

2. Possible consequences of hypoproteinemia. How to normalize the contents of protein in blood?

3. How you explain decrease of form elements and hemoglobin in blood?

4. How the level of sugar in blood in starvative person is supported?

  1. How will be changed resistence of an organism to action of the infectious agents?



Literature: 1. Gozhenko A.I., Makulkin R.F., Gurcalova I.P. at al. General and clinical pathophysiology/ Workbook for medical students and practitioners.-Odessa, 2001.

2. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/ Study guide for medical students and practitioners.-Odessa, 2003.

3. Robbins Pathologic basis of disease.-6th ed./Ramzi S.Cotnar, Vinay Kumar, Tucker Collins.-Philadelphia, London, Toronto, Montreal, Sydney, Tokyo.-1999.

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