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1 Direct bilirubin
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:
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?
3. Uric acid
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.
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).
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?
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?
Task №3: A sepsis patient has an icteric staining of scleras and skin. What pigment caused this staining of the skin?
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?
2. Hemolytic jaundice;
3. Paranchymal jaundice;
4. Obstructive jaundice;
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?
2 indirect bilirubin;
3 Direct and indirect bilirubin;
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?
2. direct and indirect bilirubin;
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?
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?
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?
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 ".
Graph of the logical structure of theme “The Mixed Dystrophy. Disturbances of the metabolism of complex proteins”
Disturbance in chromoprotein metabolism
Classification of chromoproteins
Cause & Pathogenesis
Place of hemorrhage, lungs
Venous plethora of the lungs
Disturbances of the exchange of bilirubin - jaundice
Classification of jaundice
Manifestations of cholemia
Skin, sclera, internal organs
Hemorrhagic syndrome; dystrophy of internal organs, coma, necrosis of the epithelium of kidneys ducts
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
Disturbances of the exchange of melanin
Disturbances of the exchange of nucleoprotieds
Uric acid diathesis
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
Hyper-pigmentation by melanin (general)
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