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Methodical instructions for students
Supplement number 1
Supplement number 2
" Atherosclerosis, hypertension, coronary heart disease. "
Relevance of the topic: Atherosclerosis and hypertension are chronic diseases that affects the arteries of different caliber, heart and other organs. Knowledge of the nature of the changes in blood vessels, and their pathogenesis is necessary for understanding the morphogenesis of coronary heart disease. Knowledge and skills obtained in class, contribute to understanding the causes and mechanisms of these diseases, which are necessary for proper medical attention Interpretation of clinical manifestations, diagnosis of, appointment of pathogenetic therapy and prevention of possible complications.
The purpose of (total): How to identify and interpret morphological changes: in the arteries of different caliber in atherosclerosis and hypertension, in the heart during ischemia. To represent their causes, pathogenesis, and outcomes, their use in clinical practice.
In order that you can understand the initial matches your level of skills required, we offer you perform several tasks.
Target number 1.
Histological examination of the vessel wall was found that its average shell is constructed only of elastic fibers. What is this vessel?
2. Vienna medium-sized
4. medium-sized artery
Task number 2.
Histological examination of the myocardium were found vessels whose walls are composed of three layers and the average of these contains smooth myocytes. What is this vessel?
2. medium-sized artery
Task number 3.
In patients with atherosclerosis infringement ratio lipoprotein fractions in plasma.
What level of lipoproteins sharply rises in atherosclerosis?
1. low-density lipoprotein
3. high-density lipoprotein
Target number 4.
The Authority was formed endothelium, podendotelialnoy connective tissue, muscle-elastic layer, consisting mainly of elastic fibers, smooth myocytes, collagen and reticular fibers. Provides trophic heart. What is the authority?
4. heart valve
5. coronaria heart
Task number 5.
High blood pressure and high velocity of the current in arterial due to the development of their wall mainly by certain structures. What is the structure?
1. smooth myocytes
2. collagen fibers
3. elastic elements
4. endothelial cells
Target number 6.
Histological examination revealed that the wall of the hollow body is made up of myocytes connected by intercalated disk. Between the muscle cells of loose fibrous connective tissue rich in blood vessels and nerves. What is the authority?
1. wall of the aorta
2. vessel wall
3. wall of the vein
4. ventricular wall
Standards of job responses to self-examination and self-knowledge nachalonogo Skills: 1-5, 2-4, 3-2, 4-5, 5-1, 6-4.
Information to supplement the required knowledge, skills can be found in the following literature:
1. Prywes M., Lysenko, N., V. Bushkovich / / Anatomy .- "Hippocrates", 2001. pp 376-432
2. Afanasyev YM, Yurina IA / / Histology, cytology and embryology of Medicine .- M., 1999. pp. 312-336
3. Berezov TT, Korovkin BF / / Biological Chemistry Medicine .- M., 1990. p. 41-44
4. Filimonov VI / / Normal Physiology, Kiev, "Health", 1994g.str.
Theoretical issues on which you can do the task activities.
1. Risk factors that play a role in the development of atherosclerosis.
2. Localization of changes in the arteries and the main stages of the pathogenesis of atherosclerosis.
3. The morphology of atherosclerosis, the disease stage.
4. Acute and chronic complications of atherosclerosis.
5. The concept of primary and secondary, symptomatic hypertension.
6. Stage of hypertension: functional and morphological changes in vessels, secondary changes in the organs.
7. Complications of hypertension.
8. Clinical and morphological forms of hypertension.
9. Etiology and classification of coronary heart disease.
10. Macro-and microscopic manifestations of acute and chronic ischemic heart disease.
11. Complications and causes of death in acute and chronic coronary heart disease.
Books for learning the required knowledge, skills on this topic:
1. Strukov AI, Serov VV / / Pathological Anatomy .- Kharkov, "Fact", 1999 .- S. 330-361.
2. Department of Pathological Anatomy lecture on "Atherosclerosis, hypertension, coronary heart disease."
3. Count the logical structure of the theme: atherosclerosis, hypertension, coronary heart disease.
1. Serov VV, Finger M., Hansen, TN / / A guide to practical work on Pathological Anatomy .- M., Medicine, 1998 .- S. 275-308.
2. Serov VV, Yarygin NE Spiders VS / / Pathological Anatomy. Atlas .- M., Medicine, 1989 .- S. 235-251.
3. Shlopov VG / / Basic Pathology .- Kiev, 1999.-C 262-276.
After examining the above tasks for self-mastery of the material on the topic, consists of the following targets.
Target number 1.
At autopsy, males 67 years old, revealed dense yellowish plaques in the intima of the coronary arteries of the heart, and histological examination of sections of the arteries, including macrophages and smooth muscle cells, foam cells, and identified areas of necrosis.
For what stage of atherosclerosis characterized by such changes?
5. ulcerative ateromatoz
Task number 2.
In the study of the heart from a deceased 50 years, deep in the muscles of the left ventricle was found structureless yellowish-whitish opaque area, thick consistency, with pinkish-red rim around the periphery. Histologically: cardiomyocytes nuclear-free, surrounded by a zone of hemorrhage and leukocyte shaft.
What is the process in the heart of the pathologist found?
1. myocardial infarction
2. focal myocarditis
4. diffuse cardio
5. focal cardiosclerosis
Task number 3.
I died, aged 45 from a brain haemorrhage, histological examination of brain vessels, and other internal organs revealed narrowing of the arteries of small and medium-sized with a spasm of the arterioles occurred, plasma saturation intimal hyalinosis of the walls, and in vessels of medium caliber and elastosis miofibroz.
For a disease characterized by changes in the vessels?
1. hypertonic disease
3. diabetes mellitus
4. periarteritis nodosa
Target number 4.
Microscopic examination of the coronary artery, who died of a heart attack, revealed narrowing of the lumen due to the presence in the intima of the plaque presented by the growth of fibrous connective tissue with inclusions of lipids.
What are the most likely stage of atherosclerosis?
Task number 5.
Microscopic examination of brain tissue the patient died of hemorrhagic stroke, in addition to bleeding in the brain revealed
plasmatic impregnation, hyalinosis of arterioles and small arteries, and elastofibroz sclerosis of the walls of larger arteries, edema of brain tissue. What is characteristic of
found in the brain changes?
Target number 6.
At autopsy men 72 years, in the left temporal lobe was found a cavity diameter of 2 cm, filled with clear liquid with a whitish-grayish walls. In the left-middle cerebral artery thrombus diagnosed with symptoms of an organization. The remaining part of the brain with arteries narrowed lumen. What is the most probable cause, found in the brain changes?
Target number 7.
At autopsy, 58 year old male who died of acute heart failure in the anterior wall of the left ventricle, was found flabby, pale yellowish irregular shaped plot 5-3,5 cm, surrounded by a zone of hyperemia.
Which corresponds to the observed changes?
Target number 8.
79 year old man went to a doctor with complaints of darkening of the skin of right foot. On examination, the right foot, dry cloth, black, with a clear demarcation line. Diagnosed with dry gangrene and amputation of the foot proposed. Which of the following diseases is the most likely cause of gangrene which developed in this patient?
Target number 9.
Macroscopically, the heart revealed thickening of the left ventricular wall up to 1.7 cm (heart weight was 420.0) cavity of the heart is not enlarged. Microscopically: the walls of arterioles and small arteries with signs of plasmatic imbibition and hyalinosis in large arteries intraorganic elastic hyperplasia and hypertrophy of muscle fibers.
What is characteristic of the detected macro-and microscopic changes?
Target number 10.
At the opening of women aged 57, died of a cerebral hemorrhage, were observed: hypertrophy of the left ventricle (wall thickness 2.5 cm) and small dense buds, weighing 70.0 each, with a uniformly fine-grained surface and pale, thinned to 0.2 cm layer of cortical . What disease is most likely caused changes in the kidneys?
Target number 11
Hypertensive patients died of chronic renal failure. What changes were found in the arterioles kidney microscopically?
Target number 12.
Male 56 years old, was hospitalized with a bout of angina. The ECG changes typical of myocardial infarction was found. After 15 minutes of the attack in death from ventricular fibrillation. At autopsy revealed constrictive atherosclerosis of all branches of the coronary arteries (90%) and signs of myocardial hypertrophy.
Which of the pathological diagnosis is most likely?
on a practical lesson on the theme: "Atherosclerosis, hypertension, coronary heart disease."
In early studies on the standards check homework solutions. Then, by means of test control, will be tested to prepare your lesson.
You should independently examine the macro-and micropreparations, solve situational problems.
Necessary to consider the following makropreparaty: "Atherosclerosis of the aorta," "cardiac hypertrophy in hypertension,"
"Myocardial infarction", "focal cardio", "Chronic cardiac aneurysm," "atherosclerotic nephrosclerosis", "The primary contracted kidney", "brain haemorrhage".
For this purpose, an algorithm for the Study of macropreparation (Appendix № 1).
Microscopic features of atherosclerosis, hypertension, studied in micropreparations stained with hematoxylin and eosin, Sudan 3: "Atherosclerosis of the aorta," "Stenosing atherosclerosis of coronary arteries of the heart"
"The primary contracted kidney." For this purpose, the algorithm micropreparations study (Appendix № 2).
When using microphotographs, tables on the subject must be microscopic features of atherosclerosis, hypertension, coronary heart disease.
Session ends with an analysis of the results of independent work of each student by checking the description of the test control micropreparations and learning.
Algorithm macropreparation study.
1. In the study macropreparation "Atherosclerosis of the aorta", note the presence of plaques mainly in the abdominal aorta, especially in places of origin of major branches of the abdominal aorta and bifurcation. Different color patches: yellow (lipid plaques), whitish (sclerotic plaques and atherosclerosis), which suggests a chronic, fluctuating course of illness.
Particular attention should be paid to the expansion of the lumen of the abdominal aorta and the presence of an aortic aneurysm and set its type, as well as the presence of atheromatous ulcers, the presence or absence of thrombosis in the aorta wall, and the presence of calcified plaques stony density of yellowish-brown color.
2. In the study macropreparation "atherosclerotic nephrosclerosis" to draw attention to focal, uneven renal parenchymal atrophy, which is associated with the presence of plaques and narrowing of the lumen of individual branches of the renal artery.
3. In the study macropreparation "Initially contracted kidney" - is a diffuse atrophy of uniform character, which is associated with narrowing of the lumen of all, without exception, kidneys, and arteriolar vessels of medium caliber.
Algorithm micropreparations study.
1. Micropreparations "Atherosclerosis of the aorta." At low magnification in a preparation stained with hematoxylin and eosin, examined the structure of the plaque: the presence of lipids (voids), atheromatous masses (structureless areas pink), proliferation of fibrous connective tissue and deposition of calcium salts (inclusions purple) of atheromatous mass. In the study micropreparations, stained with Sudan 3 the presence of lipids in the plaque by turning orange. Fat is also found in ksantomnyh cells (macrophages and smooth muscle cells).
2. Micropreparations "Stenosing coronary artery atherosclerosis," study the structure of microscopic plaques and set the stage of atherosclerosis. It should also pay attention to the state of myocardium, where there are atrophy of cardiomyocytes and proliferation of fibrous connective tissue (diffuse cardio) due to chronic ischemia due to narrowing of the lumen of the coronary arteries of the heart (a manifestation of chronic ischemic heart disease).
3. In the study micropreparations "Initially contracted kidney" and the tracings, it is necessary to note the changes in the arterioles: hyalinosis and sclerosis of the walls, a sharp narrowing of the lumen. In the medium-caliber arteries: thickening of the walls - elastosis, elastofibrous, hyperplasia of elastic and smooth muscle cells as a consequence of vascular changes, decrease blood flow to the kidney parenchyma atrophy and sclerosis and hyalinosis of glomeruli, tubules atrophy and sclerosis of the stroma.
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