Download Metabolic and physicochemical ch. in inflamm... 85KB 06.09.2016

MINISTRY OF HEALTH CARE OF UKRAINE
NATIONAL MEDICAL UNIVERSITY
AFTER DANYLO HALYTSKY
“Confermed”
on the methodical discussion
at the department of pathologic physiology
Chief of the department
Professor Regeda M.S.
__________________________
(signature)
“
” _____________________ 2008
MANUAL
for the students’ self-training in preparation to practical (seminar) lesson
Study discipline
Modul #
Thematical module #
Pathological physiology
METABOLIC AND PHYSICO-CHEMICAL
DISARRANGEMENTS IN THE PLACE OF
INFLAMMATION
Topic of the lesson
Year of study
Faculties
Medical
Lviv 2008
1
METABOLIC AND PHYSICO-CHEMICAL DISARRANGEMENTS
IN THE PLACE OF INFLAMMATION
I. ACTUALITY OF THE THEME
Processes of primary and secondary alteration, that is injury of tissues under the influence of the
factors, which are released from the injured cells, play a large role in the pathogenesis of
inflammation. The main manifestation of alteration is the congregation of metabolic and
physico-chemical violations in the place of inflammation. Knowledge of these violation and the
reasons of their arising are the necessary conditions for forming of the complex idea of the
pathogenesis of inflammatory process and for understanding of the mechanisms of the
emergence of cardinal signs of inflammation.
II. STUDY AIM
1. To know pathogenesis of the basic violations of matters exchange during inflammation.
2. To know the origin of cardinal signs of inflammation.
3. To be able to reproduce methodic of the determination of the fermentative activity of
festering exudate and estimate its composition and properties.
4. To know the method of determination of the principles of pharmacological corrections of
the stages of inflammatory process.
III. EDUCATIONAL AIM
To teach students (on the example of inflammation) to the individual approach in the choosing
methods of medicament correction taking into consideration reactivity of the organism and
stages of inflammation.
IV. THE CONTENT OF THE TOPIC
2
3
Hydrolytic splitting of highmolecular proteins
Accumulation of lowmolecular proteins
Increase of free fat acids
contents
Activation of lysosomic
lipases and phospholipases
Hyperosmia
Coming from blood plasma
during exudation
Increase of amino acids
contents
Activation of lysosomic
proteases
Emergence of di and
tricarbone acids
Accumulation of milk acid
Hyperosmia
Disarrangements of Crebs
circle and cell breathing
Activation of glycolysis
Release of K+ ions from
internal cell proteins
Increase of K+ ions
The basic
manifestations
Passage of K+ ions out of
ijured cells
Structurally-logical scheme of the theme’s content
PHYSICO-CHEMICAL VIOLATIONS IN THE SITE OF INFLAMMATION
Hyperosmia
#
1.
2.
3.
1.
V. PLAN AND ORGANIZATIONAL STRUCTURE OF THE TOPIC
Main stages of the topic. Its function and
Methods of
Facilities
content
control and
study
I.
PREPARATORY STAGE
Organization of the topic
See item actuality
of the theme
Setting of the educational aim
See item
educational aim
Control of the knowledge and skills entry
1. Individual
Tables
level:
oral
Slides
questioning
2. Writing
theoretical Control questions
questioning
3. Test
Test of the 2nd
control
level
II.
MAIN STAGE
Forming professional knowledge and skills
1. To know to determine amylolytic
activity of exudate.
2. To know to determine proteolytic
activity of exudate.
3. To know the technique of
performing of Rivalt test.
4. To know the technique of
performing Sokhansky test.
1.
III.
CONCLUDING STAGE
Control and correction of the level of
professional knowledge and skills
2.
Making conclusion of the lesson
3.
Home task. Educational literature on the
topic: main and additional
2
1
20
Experimental
practicum
Experimental
practicum
Experimental
practicum
Experimental
practicum
Orientation chart;
supports; tubes;
exudate;
transsudate;
thermostat; 0.1%
solution of starch;
Lugol solution;
1% solution of
casein; acetic
acid, Sokhansky
reagent; medicine
droppers.
45
Control after
correct
formulation of
the results and
conclusions of
practical work
Solution of
situation tasks
Estimation of
the students
work
Protocols of the
experiment
15
Situation tasks of
the 2nd level
5
Orientation chart
of the
independent work
4
Time in
minutes
2
VI. MATERIALS OF THE PROVIDING OF THE TOPIC
VI.1. MATERIALS OF CONTROL AFTER THE PREPARATORY STAGE OF THE LESSON
Questions for the frontal express-questioning
1. Vascular reaction during inflammation.
2. Reasons and mechanisms of exudation.
3. Lysosomes, their structure and function.
Questions for individual oral and wring theoretical questioning
1. Changes of metabolic processes in inflammatory tissue.
2. Reasons of the development of acidosis in the site of inflammation.
3. Reasons for changes of osmotic and oncotic pressure in the site of inflammation.
4. Essence of physico-chemical theory of inflammation.
5. Mechanisms of the development of the cardinal signs of inflammation (swelling, redness,
increase of local temperature, pain, violation of function).
6. Types of exudates. Difference of serous exudate form transsudate.
7. Mechanisms of proliferation and resolution of inflammation.
8. Role of nervous and endocrine systems in development of inflammation.
TEST CONTROL OF THE 2ND LEVEL
5
#
1.
2.
3.
VI.2. MATERIALS OF METHODICAL PROVIDING OF THE MAIN STAGE OF THE
LESSON
Orientation chart fro forming practical knowledge and skills
Task
Indications to the task
To learn amylolytic activity
of festering exudate
Get solution of suppurative
Suppurative exudate is usually obtained from an
exudate
experimental abscess, caused in a dog with the help of
turpentine. Suppurative exudate should be centrifuged.
Get dissolving of the
Fluid over sediment must be sucked out in a tube and
suppurative exudate
dissolved with isotonic solution of sodium chloride in the
ratio of 1:10
Take 6 tubes in a supporter. In every tube pour 1 ml of
Separate and fix the loop of
solution of starch, and later – the experimental suppurative
frog’s bowls.
exudate in the increasing quantities (from 1 to 5 drops). Put
the supporter with the tubes in a thermostat for 30 min with
the temperature 37Co.
Get the parietal thrombus
After 30 min. Take the tubes form the thermostat and put to
every tube 1 ml of starch solution and later – the
experimental suppurative serum in the increasing quantities
(from1 to 5 drops). Supporter with the tubes place in the
thermostat fo30 min with temperature 37Co. Mix the
contents of the tubes. In the control test the starch react with
iodine and gives blue colour. Amylolytic activity should be
determined in that tube where the cleavage of starch to
dextrins, which will give you soon yellow colour, took
Fix and form the results of the place.
experiment. Make
Draw and describe shortly the changes, which are observed.
conclusions.
Write down in a protocol the results received.
To determine the proteolytic
activity of festering exudate
Get dissolving of the
Get the suppurative exudate and initial solution as in the
suppurative exudate
first test. Take 6 tubes in the supporter. Put in every tube 1
ml of casein solution. Add the experimental suppurative
exudate in the increasing quantities in 5 tubes. The 6th tube
without exudate is a control one. Shake the contents of the
tubes and put to thermostat for 30 min with temperature
37Co.
After 30 min take the tubes out of the thermostat and put 2
drops of vinegar acid solution into each of them. Mix the
content of the tubes. In the control tube the solution remains
turbid. Absence of turbidity in the tubes indicates on the full
cleavage of protein by the proteolytic enzymes of the
suppurative exudate.
Fix and form the results of the
experiment. Make
Draw and shortly describe the picture observed.
conclusions.
Write down in a protocol the results received.
In a cylinder with water add 3-5 drops of vinegar acid.
Rivalt test
Further add suppurative exudate drop by drop; the clouds
appear (like smoke from cigarettes as a result of coagulation
of the protein which is present in the suppurative exudate).
Draw and shortly describe the picture observed.
6
4.
Fix and form the results of the
experiment. Make
conclusions.
Sokhansky test
Fix and form the results of the
experiment. Make
conclusions.
Write down in a protocol the results received.
Add 2 ml of Sokhansky reagent to the suppurative exudate;
discolouring of the reagent will occur as a result of changing
of the pH of condition.
Write down in a protocol the results received.
VI.3. MATERIALS OF CONTROL FOR THE CONCLUDING STAGE OF THE LESSON
1. PROTOCOL
2. SITUATION TASKS OF THE 2ND LEVEL
#1. A sick woman of 28 years old, a feeding mother, 3 weeks after childbirth felt pains in the left
breast, feeding became painful. On the third day of the illness the body’s temperature raised to
39Co, the pain in mamma became worse. Objectively: a dense formation with unclear edges is
felt in the sick breast; its sizes are 5×5 cm, is sharply painful during palpation. There are no sites
of softening and fluctuation. Redness of the skin, dilation of subcutaneous venous vessels in the
site of the breast, increase of regional lymphatic nodes are observed over the formation. During
laboratory examination it was set: the number of leukocytes – 12.4×109/l; speed of erythrocytes
sedimentation – 35 mm/h. Are there any signs, which would indicate to inflammatory nature of
the disease in woman? If yes, point out which of them.
#2. A sick woman of 32 years old complains on ache in joints, their deformation, she has sub
febrile temperature. In anamnesis: inflectional polyarthritis since 28 years. The disease flows
with frequent exacerbations. The following indexes were set during examination: the number of
leukocytes – 12.6×109/l, speed of erythrocytes sedimentation – 26 mm/h. General protein
contents in blood plasma - 7.5 g/l. Level of albumins is decreased, fraction of γ-globulins is
increased (14. %). Reaction on C-reactive protein is positive. Are there any signs, which would
indicate to exacerbation of inflammatory process in the woman? If yes, point out which of them.
#3. A sick boy of 12 years old. During examination the accumulation of fluid in the abdomen
cavity was found. For definition of the character of the fluid paracentesis (puncture of the
abdominal cavity) has been carried out. Turbid punctate of light-yellow colour was obtained. In
laboratory investigation the following indexes were found: relative density – 1.014. Contents of
protein – 0.2 g/l. Rivalt test – negative. In sediment – insignificant number of cell elements,
lymphocytes predominate. What is the character of the fluid found in the boy?
#4. A sick woman of 28 years old. During examination the accumulation of fluid in the abdomen
cavity has been found. For definition of the reasons of the development of ascites paracentesis
(puncture of the abdominal cavity) has been carried out. In paracentesis the transparent punctate
of light-yellow colour was got. In laboratory investigation the following indexes were found:
relative density – 1.014; contents of protein – 0.2 g/l; Rivalt test – negative; in sediment –
insignificant number of cell elements: neutrophils, monocytes, eosinophils. What is the character
of the fluid found in the woman?
#5. A sick girl of 14 years old. There is accumulation of fluid in pleural cavity. With the
diagnostic purpose puncture of the pleural cavity was carried out. The transparent punctate of
light-yellow colour was got. In laboratory investigation the following indexes were found:
relative density – 1.026; contents of protein – 0.35 g/l; Rivalt test – positive; in sediment –
7
insignificant number of cell elements: neutrophils, monocytes, eosinophils. What is the character
of the fluid found in the girl?
VI.4. MATERIALS OF METHODICAL PROVIDING FOR STUDENTS’ INDEPENDENT
WORK
ORIENTATION CHART FRO ORGANIZATION OF STUDENTS’ INDEPENDENT WORK
WITH EDUCATIONAL LITERATURE
# Task
Indications to the task
1
Describe violation of matters Name the main signs, which indicate to the violation
exchange in the site of
of matters exchange violations in the site of
inflammation
inflammation. Point out significance of lysosomal
enzymes in violation of matters exchange during
inflammation.
2
Name the physico-chamical
Name the reasons of emergence of acidosis in the site
changes in the site of
of inflammation. Indicate the reasons of the increase
inflammation
of osmotic and oncotic pressures in an inflammatory
tissue.
3
Characterize process of
Point out sequence of manifestation and role of
proliferation
different populations of cells in the site of
inflammation.
4
Explain role of reactivity of
Give the example of influence of the nervous system
the organism in development on flowing of a disease. Explain the mechanisms of
of inflammation
anti-inflammatory action of corticosteroids.
VII. REFERENCE
Educational:
A. Main
1) Pathological physiology. After redaction of A.I. Bereznyakova. Charkiv: Zoloti storinky.
2003
2) Pathological physiology. After redaction of M.N. Zayka, Yu.V.Byts. Kyiv: Vyshcha shkola,
1995.
B. Additional
3) Pathological physiology. After redaction of A.D. Ado, V.V. Novytsky, Tomsk: Un-ta. 1994
4) Pathological physiology. The course of lectures. After redaction of P.F. Letvitsky,
M.:Medicina.1995
5) Agadganyan N.A. Organism and gas environment. M., 1972
6) Big medical encyclopedia
7) Kolchinskaya A.Z. Oxygen, physical state, working ability. K.: Naukova dumka.
8