Download Methodological Instruction to Practical Lesson № 12

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 2 : PATHOPHYSIOLOGY OF THE ORGANS AND SYSTEMS.
Contenting module 5. Pathophysiology of blood circulation
and respiratory system.
Theme 12: Final control-5.
Chernivtsi – 2008
1.Actuality of the theme. Strife with a heart insufficiency - major problem
of national public health services. Its national significance is determined by a high
morbidity and death rate, large labor losses, considerable traumatism. The heart
insufficiency often arises on ground of necrotic damages of cardiac muscle. Quantity
both coronarygenic and epinephrine and norepinephrine genesis damages of the
myocardium recently increases, which one result from a stress, mental overstress,
excessive phisical loads. The warning of necrotic, inflammatory, metabolic,
neuroendocrine and other damages of the myocardium is the constituent of preventive
maintenance of heart insufficiency. The new scientific direction - preventive
cardiology was now formed, problems by which one include warning and early
detection of cardiovascular system function disorders.
The disorders of the vasculare tone arise for action of the various factors of the
external and internal environment. It is distinguished two main groups of such
disorders: arterial hypertension and arterial hypotension. Hypertensive disease as one
example of arterial hypertensions is the important problem of modern medicine. It is
necessary to take into account that fact, that in 50 % of the men and in 75 % of the
women, which suffer by hypertension the decrease of duration of life for 10 years is
revealed fast progress atherosclerosis, symptom of heart ischemic disease. At the
sometime many physicians frequently has deal with the patients in which the
parameters of arterial pressure are sharply reduced (shock, collapse). The number of
such patients in 4 times exceeds frequency of heart-vessels and malignant diseases,
and in connection with acceleration of scientific and technical progress the tendency
to growth of this kind pathology is observed.
The disorders of cardiac rhythm concern to complex manifestations of
pathology of heart. Its can arise in rather small damage of the conducting system, and
in some cases in structural changes. More often arrythmia arise with infectious
illnesses and intoxications as consequence of miocarditis or dystrophy processes in
cardiac muscle, and also in heart ishemic disease, cardiosclerosis. The disorders of
cardiac rhythm arise also owing to reflex influences from various interreceptors areas
(disease of liver, intestinal tract, uterus), and also in hemodynamic disorders
(arterial hypertension). Not infrequently аrrythmia is a result of disturbance of
functions central and vegetative parts of nervous system. For example, the increase
of activity parasymphatic nervous system lead to delay of conductivity. Similar is
observed also by overdose of some medicin drugs (digitalis, quinidine, morphine). If
bradycardia is accompanied complete atrioventricular blockade, can occur ischemia
of brain with loss consciousness and occuring spasmes. Arrythmia can be result in
development of cardiac insufficiency.
The disorder of external breath arise for action of the various factors of the external
and internal environment, however all of them for the mechanism of development are
united in three groups - ventilating, diffusing and perfusing. The most seriosly by
manifestation of disorder of external breath is respiratory insufficiency is, as a result
of which the gas structure of blood is changed and arises dispnea. On character of
dispnea it is possible to make submission about the reason of a pathology. In
particular, the deep and often breath arises for cardiac-vascular was insufficiency and
anemias, deep and rare - for stenosis of respiratory paths, often and surface – for
inflammation or edema lungs. Enougth frequently respiratory insufficiency arises due
to of disorder regulation of influences on the side of respiratory centre. Excitability of
respiratory centre is reduced owing to damages of the central nervous system: a
sclerosis, spasms of vessels of brain, insults, compresion of brain by tumour, toxical
action on respiratory centre of sleeping and narcotic medicine. The periodic breath,
which arises owing to oppression of respiratory centre. The breath of Cheyne-Stokes’
is more often observed for functional changes, and breath of type Biott - for organic
damages of brain. From peripheral mechanisms primary significance have the
disturbances of adequate constriction of respiratory muscles.
Respiration insufficiency is a pathologic process developing due to the
disturbance of the external respiration. In respiration in sufficiency the maintenance
of gas contents adequate to organism requirements isn't ensured. Even at rest
respiration insufficiency may lead to hypoxia and gaseous acidosis or limit the
organism abilities as fulfill physical work. The main mechanisms of respiration
insufficiency development consist in disturbances of ventilation, perfusion, diffusion
as well as their quantitative ratio.
2.Length of the employment – 2 hours.
Aim:
To khow etiology and risk factors of heart disease, the heart hypertrophy,
hypertension, hypotension, characterize the periodical breath, characterize
obstructive pulmonary diseases.
To be able: to analyse the pathogenesis of right and left side heart failure, of
the heart hypertrophy, hypertension, hypotension,
the periodical breath,
obstructive pulmonary diseases.
To perform practical work: To analyse the tests, clinical-pathophysiological
schemes, tables with pathology of the of right and left side heart failure, the heart
hypertrophy, hypertension, hypotension, periodical breath, obstructive pulmonary
diseases.
Control questions of the theme
1. Describe the flow of blood through the heart and identify the coronary vessels.
2. Describe the conduction system of the heart.
3. Describe the interrelationships between myocardial stretch and chamber wall
dimensions and the contractible force of the heart.
4. Establish the determinants of blood flow.
5. What is etiology and risk factors of heart disease?
6. Describe the compensatory mechanisms cardio-vascular diseases. The
principal compensatory mechanisms are:
7. Mechanisms of myocardial hypertrophy.
8. Classify the heart diseases
9. Identify the causes and manifestations of valvular dysfunction.
10.Compare the pathophysiology, manifestations of right and left side heart
failure.
11.Characterize coronary artery disease; distinguish between myocardial ischemia
and myocardial infarction and list complications of each.
12.What is reperfusion syndrome?
13.Distinguish between primary, secondary, complicated, and malignant
hypertension.
14.Some Causes of Secondary Hypertension: renal disorders, endocrine disorders,
vascular disease, neurologic disorders, acute stress.
15.Disturbance of automatism.
16.The disturbance of conduction.
17.Arrhythmia due to simultaneous disturbance of automatism and conduction.
18.Circulatory insufficiency in disturbance of the blood inflow to the heart.
19.Compare the structural changes of the lower airways as the source of air
movement toward the alveoli.
20.Define the measurements of lung volumes and capacities.
21.Describe the diaphragmatic movement in inspiration and expiration; indicate
other factors involved in the mechanism of breathing.
22.Define the terms used in describing the signs and symptoms of pulmonary
disease.
23.Characterize the periodical breath
24.Name the main signs of pulmonary disease
25.Pulmonary defenses.
26.What is the main cause of damage of the pulmonary defenses?
27.What is lung collapse and pneumothorax?
28.Characterize obstructive pulmonary diseases.
29.Define pneumonia and describe its causes and manifestations.
30.Characterize pulmonary embolism, pulmonary hypertension, and cor
pulmonale.
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.P.170-202.
2. Gozhenko A.I., Gurcalova I.P. General and clinical pathophysiology/ Study guide
for medical students and practitioners.-Odessa, 2003.- P.224-258.
3. Robbins Pathologic basis of disease.-6th ed./Ramzi S.Cotnar, Vinay Kumar, Tucker
Collins.-Philadelphia, London, Toronto, Montreal, Sydney, Tokyo.-1999.- P. 697753.