Diseases of the digestive icon

Diseases of the digestive

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Diseases of the digestive

(Non-specific general disease small intestine and colon, chronic hepatitis, cirrhosis, penkreatity).

Relevance of the topic. Diseases of the digestive organs, which are now exploring different sharp increase in their frequency, threatening, even fatal complications, which occur acutely or chronically. Prevention is possible through their early morphological diagnosis, treatment and diligent with the morphological control efficiency.

Knowledge of the nature and morphological manifestations of diseases of liver, pancreas, small intestine and colon are needed to study them in the departments of therapy, infectious diseases, surgery, and the work of doctors.

The purpose of (total): able to determine the macro-and microscopic manifestations of diseases of the digestive system, to be able to explain the causes and mechanisms of their development, to assess the credibility and value to the body of possible complications.


The specific objectives

The purpose of the entry-level

be able to:

1. Identify morphological features of non-specific inflammatory bowel disease, explain the mechanism of development, and assess the significance of the result of possible complications

1. Identify sections of the colon (Department of Anatomy), and histological structure of the mucosa (Department of Histology)

2. Identify the morphological features of chronic hepatitis, the degree of activity, explain the mechanism of development, and assess the significance of the result of possible complications

2. Identify sections of the pancreas (head, body, tail) (Department of Anatomy) and its histological structure of the (Department of Histology)

3. Identify morphological liver cirrhosis, explain the mechanism of development, assess the significance of potential complications.

4.Raspoznavat morphological signs of acute and chronic pancreatitis, explain the mechanism of the development, investigation and assess the significance of possible complications

3. Identify the particle (left and right) and the liver (Department of Anatomy), and especially the histological structure of the epithelial structures (hepatocytes and epithelial ducts) and stromal (Department of Histology)

In order for you to realize as to whether the initial level of your knowledge, skills required, we propose to perform multiple tasks.

The tasks for self, self-knowledge source-level skills

Objective number 1. Microscopic examination of histological specimens revealed deep crypt, in which goblet cells predominate over cylindrical, no cell Panetta. For some digestive tract characterized by a structure of the mucous membrane?



3.Dvenadtsatiperstnoy intestine

4.Tonkoy intestine

                    5.Tolstoy intestine

Objective number 2. Microscopic examination revealed lobular histology drug structure body parenchyma which is presented by epithelial cells, which form a beam between them are sinusoids with blood. The center is located vessel segments of venous type. Between slices in small fields of connective tissue located artery, Vienna and small duct. For a body characterized by a histological structure?



3.Podzheludochnoy cancer


                    5.Slyunnoy cancer

Objective number three. Microscopic examination of histological specimens revealed that the body consists of many densely arranged glands, acini, consisting of epithelial cells with basal nuclei and the location of dark granular cytoplasm, separated by thin layers of connective tissue in the lobules. Among them are pale-colored cells that constitute the strands and irregular clusters. For a body characterized by such a structure?



3.Podzheludochnoy cancer


                    5.Slyunnoy cancer

The correctness of problem solving test, comparing them with the standards of response.

Standards of responses to meet the challenges for self-starting and self-knowledge, skills: 1-5, 2-4; 3-3.

Information necessary to replenish the necessary knowledge, skills can be found in the following literature:

  1. Prywes M., Lysenko, N., V. Bushkovich Human Anatomy. - _.: Hippocrates, 2001. - S. ___-___.

  2. Afanasyev YM, Yurina IA Histology, cytology and embryology. - G.: Medicine, 1999. - S. ___-___.

The content of education must ensure the achievement of learning objectives, which assists the logical structure of the Count theme "Diseases of the digestive system" (Appendix № 1).

The basic theoretical issues on which the possible implementation of targeted activities

  1. Hepatitis: etiology, pathogenesis, morphology of chronic hepatitis, outcome and significance of potential complications.

  2. Cirrhosis of the liver: etiology, pathogenesis, classification, morphology, and the value of the outcome of possible complications.

  3. Pancreatitis: classification, etiology, pathogenesis, morphology, outcome and significance of potential complications.

  4. Inflammatory bowel disease: classification, etiology, pathogenesis, morphology, outcome and significance of possible complications of nonspecific ulcerative colitis (NUC) and Crohn's disease.

Literature to develop the necessary knowledge, skills for this topic:

  1. Strukov AI, Serov VV Pathologic anatomy. - Kharkov: Fact, 1999. - S. ___-___.

  2. Lectures for the Department of the theme of "Diseases of the digestive system."

  3. Count the logical structure of the theme "Diseases of the digestive system" (Appendix № 1).

Further reading:

  1. Shlopov VG Fundamentals of pathological anatomy. - Kiev, 1999. - S. 305-322.

  2. Serov VV, Yarygin NE, Spider VS Pathological Anatomy: An Atlas. - G.: Medicine, 1986. - S. ___ ____.

Perform the following targets

Objective number 1. Male 60 years old died from gastrointestinal bleeding. At autopsy: the lower one-third of the esophagus rapidly cyanotic, varicose veins are twisted, enlarged. The liver is a small, dense, uneven surface with the presence of tubercles up to 3 mm, microscopically lobed structure is broken, some segments are not the central vein, there gidropechnaya, fatty degeneration and necrosis of hepatocytes and diffuse fibrosis. What is the most likely diagnosis?

1.Melkouzlovoy cirrhosis of the liver;

2.Krupnouzlovoy cirrhosis of the liver;

3.Smeshanny cirrhosis of the liver;

4.Ostry hepatitis;

5.Hronichesky hepatitis.

Objective number two. The immediate cause of death of men 60 years old, who lives with cirrhosis, acute anemia was common. Massive bleeding is a complication of coca localization of liver cirrhosis, which led to the death?

1.Ostrye stomach ulcer;

2.Ostrye ulcers of the esophagus;

3.Varikozno veins of the esophagus

4.Hronicheskaya duodenal ulcer;

5.Hronicheskaya gastric ulcer.

Objective number 3.

During the holidays, the surgical department of hospitalized young man whose home 12:00 to an acute, very intense pain in epigastralnoy area and back. In a patient with a picture of a painful shock from which it could not withdraw. In the context of almost the entire pancreas is enlarged, red, round it to tiny pockets of fat that resemble stearin spot. What is the most likely diagnosis?

1. Chronic pancreatitis with exacerbation

2. Acute pancreatitis is a serous

3. Acute suppurative pancreatitis with hemorrhage.

4. Acute pancreatic necrosis

5. Acute Hemorrhagic pancreatitis sero-

Objective number 4.

In needle biopsy of the colon crypts are isolated goblet cells in which vacuoles of mucus does not RAS-reaction. The surface epithelium is thin, with necrosis of the cells. Dense cellular infiltrate composed of lymphocytes, plasma cells, eosinophils, neutrophils, accumulation occurs in the lumen of the last of the crypts. What is the most likely diagnosis?

1. Crohn's Disease

2. Acute colitis

3. Chronic atrophic colitis

4. Nonspecific ulcerative colitis

5. Ischemic colitis.

Objective number 5.

The young man was hospitalized with symptoms of acute peritonitis. When the operation is found very narrowed segment of the small intestine with the presence of scar tissue around a small ulcer about 1 mm defect. Outside this segment of the small intestine of conventional properties. What is the most likely diagnosis?

1. Crohn's Disease

2. Acute enteritis

3. Chronic atrophic enteritis

4. Nonspecific ulcerative colitis with a lesion of the small intestine

5. Infiltrative carcinoma with perforation.

Methodical instructions to work on a practical lesson, students "Diseases of the digestive system"

In early studies on the standards of answers check home solutions of the problem. Then by the test control will be tested to prepare your lesson.

You have to learn on their own macro-and micropreparations, solve situational problems. Macro-and microscopic manifestations of peptic ulcer disease, cirrhosis of the liver melkouzlovogo studied at the macro and micropreparations: "Cirrhosis of the liver." In this instruction is used to study makropreparatov (application number 2) and micropreparations (Annex № 3).

Classes are completed analysis of the results of independent work of each student by checking the description of the test control micropreparations and learning.

Appendix № 2

Instructions for the Study of makropreparatov

  1. Identify the authority

  2. Dimensions

  3. Form

  4. Surface

  5. Consistency

  6. Color

  7. Drawing on the cut

  8. The nature of focal changes

  9. Call the disease process

Appendix № 3
Instructions for the Study of micropreparations

At low magnification to study medicine, to establish authority. Find the field of view with pathological changes, to determine their nature. special features. Formulate a conclusion about the nature of the pathological process.

Appendix № 4

Morphological changes that are found in the study of macro-and micropreparations

^ The Authority


The macroscopic picture

Reduced in size, thick, with a uniformly fine-grained surface (nodules less than 3 mm in diameter), separated by uniform with narrow streaks of connective tissue


The parenchyma contains numerous false lobules with disturbed beams, separated by narrow layers of connective tissue, hepatocytes phenomenon dystrophy, atrophy and regenerative changes


^ Melkouzlovoy cirrhosis

Count the logical structure of the theme, "Diseases of the digestive system"






^ Inflammatory bowel disease

On the clinical course:

--- Sharp

--- Chronic:

--- Nonspecific ulcerative colitis (NUC)


Immune disorders, genetic tendency, impaired secretion

In the colon throughout numerous surface defects (ulcers) in conjunction with the proliferation of the epithelium (polipoobrazovanie) micro - predominantly lymphoplasmacytic inflammatory infiltration of the mucous membrane, sometimes mixed with EPMYAL or NPMYAL, reducing the number of goblet cells and mucus in them, crypt abscesses, sometimes extraintestinal defeat

Difficult toxicity, cachexia, bleeding, pre-cancerous changes

----- Crohn's disease


Immune disorders, genetic propensity

Predominantly terminal ileitis, but can damage the entire digestive tract with the presence of narrow slit-shaped, deep ulcers, which alternate with patches of cicatricial stenosis of the lumen and the areas of normal organ structure, micro - lobular lymphoplasmacytic inflammatory infiltration in all layers,

sometimes epithelioid cell granulomas, vasculitis, characterized by lesions and normal colon. Sometimes vnekishechye defeat

Perforation, peritonitis, rarely - bleeding


On the clinical course:


Hepatitis B, C, delta, etc., drugs, alcohol, hepatotropic poisons (carbon tetrachloride), autoimmune processes, biliary hepatitis

Acute or chronic inflammation of alterative

- Weak

- Moderate

-Severe activity

And chronicity

Macular degeneration, atrophy of hepatocytes necrosis, lymphocytic infiltration of portal tracts and parenchyma, the connective tissue septa presence sclerosis



On morphology:

- Melkouzlovoy (up to 3 mm)

- SKD (> 3 mm)

- Mixed

Viral, alcoholic, toxic, autoimmune, biliary

Postnekrotichesky, portal, mixed

Macro - the surface of small-or krupnobugristaya, the liver is reduced in size, thick, tapered edge; micro - a violation of lobed and beam structure, degeneration and necrosis of hepatocytes, the presence of fake lobes, diffuse fibrosis, regeneration of hepatocytes and bile ducts

Gepatargiya, portal hypertension (ascites, splenomegaly, varicose veins anastomoses porto-caval), bleeding from the varices mainly the lower third of the esophagus


Of origin:

- Primary

Alcohol, drugs medical, fatty foods

Violation of cross-duct of the pancreas (Wirsung), bile reflux, poor circulation (shock), the activation of enzymes PZHZH, autolysis

- Secondary

Diseases of the gastrointestinal tract - cholecystitis, cholelithiasis, biliary dyskinesia, gastric ulcer and duodenal ulcer

On the clinical course:

- Acute:



Shock, peritonitis

Hemorrhagic necrotic-

- Chronic

The replacement of the exocrine parenchyma by fibrous tissue

Malabsorption syndrome, steatorrhea, malabsorption of vitamins zhirorozchinnih, cachexia


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