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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.


Theme21: Final control - 3.


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.

Diabetes mellitus is a disease resulting from absolute or relative insulin insufficiency and accompanying by disturbance of metabolism mainly, carbohydrate one. The main manifestation of diabetes mellitus is hyperglycemia, sometimes reaching 25 mrnol/1, glucosuria with glucose in urine up to 555-666 mmol/1 (100-200 g/day), polyuria (to 10-12 I of urine per day), polyphagia and polydipsia. It is also characterized by the increased level of lactic acid (lactocydemia) — over 0.8 mmpl/1 (N — 0,033-0,078 mmol/1); lipemia — 50-100 g/1 (N — 3,5-8 g/1), sometimes ketonemia (by determination of acetone) with the increased level of ketone bodies to 5200 mcmol/1 (N < 517 mcmol/I).

Atherosclerosis – exceptionally widespread disease. On data WHO, mortalitis of the patients in the age 35-44 years for damages of heart and vessels connected with atherosclerosis, increased lately by 60 %. The knowledge of the reasons and mechanisms of atherosclerosis development is necessary for the doctors of various profession for prophylaxis and treatment of this disease. According to modern notions, main etiological factors of atherosclerosis is dyslipoproteinemia and increased permeability arterial wall for lipoproteins. The primary prophylaxis foresee realization of such methods, as organization of rational nutrition, early preventing obesity, increase of physical activity, revealing and treatment arterial hypertension and diabetes mellitus, fighting with smoking and abusing by alcohol.

The state of dehydratation can arise in the person in time stay on place with hot climate owing to excessive of sweating and hyperventilation. However water deficiency is more often is observed for various pathological states - strong diarrhea, vomiting, complicated swallowing (tumour, atresia of the esophagus), extensive burns, significant blood loss, diseases of brain, which are accompanied by absence of thirst sensation, in the heavy patients and weakened children. This state especially is dangerous for children first two years life in connection with disorder of neuroendocrine regulation of water-electrolytes metabolism. Dehydration in them quite often lead to death.

For dehydration there are changes both the side of liquid, and from the side electrolytes. Their amount in this state can be increased (hyperventilation, strong sweating), or decrease (diarrhea, vomiting, diabetes insipidus). The loss of electrolytes lead to disorder of the acid-base balance. Because treatment directed on restoring water-electrolyte balance, should take into account not only degree dehydrotion and loss electrolytes, but also degree of the acid-base balance disorder.

The normal functioning of an organism is possible only under condition of biochemical stability of its liquids, which is named homeostasis. The acid-base balance, maintenance of concentration of hydrogen ions (рН) in blood, lymph, tissues, spinal cord and other liquids in a rather narrow range (for blood 7,35-7,45) concerns to major elements of the homeostasis. This persistance of рН is necessary, the first of all, for maintenance of enzyme activity. It is provided with buffer systems of blood (bicarbonate, phosphate, protein, hemoglobin buffers) and some organs (lungs, kidneys, stomach, intestine). The disorder of acid-base balance can be considered as the original form of pathology metabolism. Its essence is in increase of the contents of liquids of an organism of substances of acid or alkaline character. The state, for which the acid compound prevail is named acidosis, the opposite one is alkalosis.

The disorders of acid-base balance arise very frequently. For example, acidosis is accompanied by such diseases and pathological states as diabetes mellitus, starvation, deep hypoxia, shock, collaps, damage of liver and kidneys, oppression of respiratory centre by drugs, lungs edema, pneumonia. Аlkalosis arise after introduction of big quantities of sodium bicarbonate, as a result of significant loss of gastric juice (pylorostenosis, cancer, unrestrained vomiting of pregnant women), in hyperthermia, encephalitis, attacks of epylepsia and hysteria, breathing by rare air, excessive artificial ventilation of the lungs. The significant fluctuations of blood рН leads to irreversible changes of the vital organs and death of an organism. Shifts of рН become dangerous to life, if the mechanisms of regulation of acid-base balance are not capable to compensate influence of acid or basic substances. In these cases the correction of acid-base balance becomes extremely necessary. It is realized after preliminary definition of indexes, which characterize state of acid-base balance of the patient.

^ 2.Length of the employment – 2 hours.

3.Aim:

To khow: pathology of the disturbance of energy, protein and basal metabolism, starvation; pathology of the carbohydratic metabolism, diabetis mellitus, pathology of lipide metabolism, atherosclerosis, pathology of water-electrolyte metabolism, acid-base imbalance.

To be able: to analyse the pathogenesis of the disturbance of energy, protein and basal metabolism, starvation; of the carbohydratic metabolism, diabetis mellitus, of the lipide metabolism, atherosclerosis, of the water-electrolyte metabolism, acid-base imbalance.

^ To perform practical work: to analyse the tests, clinical-pathophysiological schemes, tables with pathology of the disturbance of energy, protein and basal metabolism, starvation; of the carbohydratic metabolism, diabetis mellitus, of the lipide metabolism, atherosclerosis, of the water-electrolyte metabolism, acid-base imbalance.

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.

  7. Site of origin and effects of hormones.

  8. Describe the main cause of pancreas alterations.

  9. Pathogenesis of diabetes mellitus.

  10. Note the Classification of Diabetes and Glucose Intolerance Conditions.

  11. Identify the acute complication of diabetes mellitus; describe the features of each.

  12. Describe the chronic complications of diabetes mellitus.

  13. The role fat in the organism.

  14. Name types of hyperlipoproteinemias due to HWO’s classification.

  15. Disturbances of lipide metabolism

  16. Characterize atherosclerosis, the main risk factors and pathogenesis.

  17. Describe obesity. What is the role of genital, constitutional and environmental factors in their development?

  18. Distinguish between hypertrophic and hyperplastic obesity.

  19. Relative size of the body fluid compartments expressed as percentage of total body water.

  20. Describe the balance concept.

  21. What is a positive balance of water metabolism?

  22. What is negative water balance?

  23. What are the consequences of fluid imbalance?

  24. How is electrolyte imbalance characterized?

  25. Learning information about other electrolytes is given in the following.

  26. What is the mechanism of edemas?

  27. Several principal pathogenic factors of edema.

  28. The buffer systems of organism.

  29. Acidogenesis.

  30. Ammoniogenesis.

  31. Transformation of alkaline phosphates into acid.

  32. Types of acid-base balance disorder.

  33. Metabolic acidosis.

  34. Gas acidosis.

  35. Metabolic alkalosis.

  36. Gas alkalosis.

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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