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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